Main Line Health, United Healthcare contract dispute could leave 32,000 patients out-of-network later this month
The nonprofit health system's current UnitedHealthcare contracts for employer-sponsored insurance and Medicare Advantage plans expire June 30. The plans cover 32,000 Main Line patients.
Chris Feaster sees Main Line Health clinicians for mammograms, breast MRIs, and other preventive screenings required due to her high risk of breast cancer.
The 61-year-old Montgomery County resident has been panicked in recent weeks after Main Line sent patients a letter warning that the nonprofit health system’s contract with her insurer, UnitedHealthcare, may end later this month.
Main Line is a leading provider of care across Philadelphia’s western suburbs, where it has four hospitals. Feaster has relied on its facilities for care for 40 years.
“They know me,” she said of her Main Line providers in an interview. “I have been getting monitored there since the time I was in my early 30s.” .
Feaster, who lives in Trooper, has already experienced a healthcare disruption caused by another insurance dispute. Two years ago, Axia Women’s Health and United failed to reach adeal. That forced Feaster to find a new gynecologist after 40 years.
If no deal is reached by June 30, Feaster could be facing a repeat. She is among 32,000 affected Main Line patients who have United insurance through Medicare Advantage plans and commercial insurance from employers.
It’s not unusual for health systems and insurers to go down to the wire when negotiating contracts, but Axia’s failure to reach a deal — and the decision by Jefferson Health’s Lehigh Valley Health Network to go out of network with United — has people on edge.
Main Line Health said that United had been engaging more meaningfully in negotiations in recent weeks. “We are hopeful that momentum continues. We remain committed to reaching a resolution before June 30,” its statement said.
For Main Line, which is far less profitable than it was before the pandemic, the dispute is not just about rate increases. The nonprofit health system also wants to reduce claim denials, prior authorization delays, and excessive audits.
UnitedHealthcare focused on prices in a statement, and the impact high costs have on employers who pay for health benefits.
“Main Line Health is seeking price hikes that would significantly increase costs for families and employers,” UnitedHealthcare said.
United added that self-insured companies would absorb the biggest hit ”impacting the money they have to grow their business and compensate their employees.”
Worries about maternity care
Jessica Geida, a Newtown Square resident and an ob/gyn who is not currently practicing, is particularly worried about access to maternity care in Delaware County, given that Axia is already out of network with United.
Main Line operates the only practice that delivers babies at Riddle Hospital for people with UnitedHealthcare (UHC) , said Gaida, who has worked at Axia and Main Line. “If they drop UHC, there would be no access to care in the Delaware County,” she said.
Maternity care has been under pressure in Delaware County since the maternity unit closed at Delaware County Memorial Hospital in early 2022, followed by the shutdown of Crozer-Chester Medical Center a year ago as part of the Prospect Medical Holdings bankruptcy.
Mercy Fitzgerald Hospital in Darby closed its labor and delivery unit more than 20 years ago.
If Main Line and United fail to reach a deal, UnitedHealthcare patients might have to go to Penn Medicine’s Chester County Hospital in West Chester, which is already busy.
Patients who get into Penn’s ob/gyn practice at Penn Medicine Radnor deliver babies at the Hospital of the University of Pennsylvania in Philadelphia, according that group’s web site.
» READ MORE: Main Line Health had a narrow operating profit in the nine months ended March 31
A disappointing call
Feaster said a call from UnitedHealthcare Friday left her feeling very uncertain about her care.
Feaster grew up in Wayne and kept seeing Main Line doctors when she moved to Trooper, which is north of King of Prussia.
Feaster would have to specially request a continuation of care to keep seeing each of her Main Line doctors at in-network prices, the UnitedHealthcare representative told her.
The temporary stopgap is designed to help people who have significant needs — including cancer patients in the middle of treatment — avoid gaps in care while they switch to doctors who accept their insurance.
Feaster would have to fill out part of the form, and her doctors would have to complete another part. She’d also have to take the same steps for Main Line providers of her regular mammograms, breast MRIs, and DEXA bone density scans.
UnitedHealthcare would then review each request to determine whether to approve.
“I’m really worried,” she said.
