“Surprise” bills from medical personnel who are not in network, despite working at in-network facilities, are becoming a major scourge for patients. (Photo: Getty)
UnitedHealth Group has warned some 700 hospitals that staffing firm Envision Healthcare could be out of network next year.
Hospitals were warned that they and patients could be in for big bills, according to Modern Healthcare, because of its emergency department billing practices. UnitedHealth blames the failure of contract negotiations between itself and Envision because Envision “demands to be paid much more than Medicare pays for the same services,” says the report.
If the companies do not resolve their differences and extend Envision's in-network status past Dec. 31, patients could be the ones faced with big out-of-network bills if they're treated by an Envision-staffed emergency department or by some other departments for which Envision also provides staff. In addition, the hospitals themselves could find themselves stuck for the bills for uncompensated care.
“Surprise” bills from medical personnel who are not in network, despite working at in-network facilities, are becoming a major scourge for patients.
UnitedHealth's letter said, “In the event patients receive services from an Envision provider, you may experience a decrease in patient satisfaction driven from higher out-of-pocket costs and patient confusion.”
Envision, for its part, said in a statement that UnitedHealth's letter is “filled with half-truths and inaccuracies.”
Modern Healthcare quotes Envision saying, “We've worked hard to shift to an in-network relationship with United and now they want to undo all that progress in one day.”
The dispute has been ongoing for months, with Envision supposedly sending large “surprise” bills to patients. In March, Envision sued UnitedHealth, the report says, “claiming the insurer violated their contract by refusing to add Envision doctors to its network, unilaterally lowering payment rates, and then trying to collect more than $140 million in what it considered overpayments to the staffing firm.”
In April the suit was dismissed, and the judge told the companies to enter arbitration. However, UnitedHealth set up a website that targeted Envision's “outrageous billing practices,” citing the staffing firm's physician charge of $992 for an emergency department visit for a patient with chest pain, while pointing out that in-network doctors instead charge only an average of $351.
UnitedHealth isn't the only one complaining about Envision's billing, with a Yale University study from 2017 revealing that hospitals outsourcing ED care to Envision saw rates for out-of-network care, tests and admissions from EDs all rise.
Private equity firm Kohlberg Kravis Roberts & Co. is expected to close on the purchase of Envision in October; the deal was approved for $9.9 billion in cash and assumed debt earlier this month.
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
