Lehigh Valley Health Network expects to go out of network for UnitedHealthcare’s Medicare Advantage plans Monday
The failure of LVHN and UnitedHealthcare to reach a contract will affect more than 20,000 Medicare Advantage patients, Jefferson said.
Jefferson Health’s Lehigh Valley Health Network is expected to go out of network Monday for members of UnitedHealthcare’s Medicare Advantage plans.
That means about more than 20,000 people who get care at LVHN facilities could experience disruptions in their care if a last-minute deal isn’t reached. Two years of negotiations failed to result in a new contract, Jefferson said in a statement Wednesday.
Jefferson also said that United reduced payments to LVHN by nearly 40% since 2021, reducing the nonprofit health system’s revenue by more than $100 million over four years.
“When an insurer stops paying agreed‑upon rates and refuses to negotiate, patient access is put at risk. Jefferson and LVHN will not stand by while an insurer prioritizes its own margins over fair contracts and sustainable care,” said Jeffrey Price, a Jefferson senior vice president involved in managed care and payer relations.
LVHN patients who have UnitedHealthcare plans through their employers will remain in-network at the nonprofit system through most of April, Jefferson said.
The dispute does not affect Philadelphia-area Jefferson patients with insurance from UnitedHealthcare, the nation’s largest health insurer.
Jefferson first warned in October that its LVHN facilities would start going out of network this month.
At the time, United suggested that Jefferson’s announcement during the Medicare Advantage annual enrollment period was a negotiating tactic designed to put pressure on United.
United did not immediately respond to a request for comment Wednesday.
If LVHN does go out of network with United, it will join other well-known systems to have done so in the last year. They include Johns Hopkins Medicine and Mayo Clinic, though in some cases group retiree plans remain in network at Mayo.
Last March, Jefferson went out-of-network with Cigna Health for a few weeks during a similar impasse in negotiations. Jefferson and Cigna quickly reached a deal after the termination.