Federal law protects some Vermonters losing UnitedHealthcare coverage

Dan D'Ambrosio, Burlington Free Press
·3 min read

Vermonters losing health insurance coverage because UnitedHealthcare canceled its contract with the University of Vermont Health Network are protected by a federal law that requires continued care for patients undergoing treatment for conditions such as cancer, as well as those who are pregnant, according to a Vermont regulator.

The Vermont Department of Financial Regulation said last week the No Surprises Act requires health plans to allow patients being treated for "serious and complex conditions" to receive the same benefits, under the same terms and conditions as would have applied if the plan wasn't terminated − for the "full course of treatment furnished by the provider."

Department of Financial Regulation Commissioner Kevin Gaffney said Monday he has talked directly to UnitedHealthcare and has "no concern" about their commitment to comply with the No Surprises Act.

"If someone is experiencing something other than the message we're delivering they should reach out to us," Gaffney said.

Nearly 2,000 Vermonters affected by loss of coverage

UnitedHealthcare's decision to terminate its contract with UVM Health Network affects 1,911 Vermonters, who will lose their in-network coverage, provided primarily through their employers, according to the DFR. Gaffney said the protection of the No Surprises Act also includes any emergency services, in addition to serious health conditions.

"This is not an ideal situation, but I think the No Surprises Act does a good job of providing a safety net," he said.

The University of Vermont Health Network said in a news release on Feb. 21 that despite "many attempts" to reach an agreement with UnitedHealthcare the insurer decided to allow its contract with the Network to expire as of April 1, 2023.

"This will have a serious impact on our patients who subscribe to UnitedHealthcare's commercial insurance, and we are disappointed they have made this decision rather than attempt to come closer to payment rates approved by the Green Mountain Care Board that more accurately reflect the cost of providing health care in 2023 and align with rate increases negotiated with other Vermont payers," Dr. Sunny Eappen, president and chief executive officer of the UVM Health Network, said in a statement.

Staff care for a new arrival to the University of Vermont Medical Center Intensive Care Unit (ICU) on Thursday, Dec. 2, 2021.
Staff care for a new arrival to the University of Vermont Medical Center Intensive Care Unit (ICU) on Thursday, Dec. 2, 2021.

UnitedHealthcare disputed the health network's characterization of negotiations in its own news release on Feb. 24, saying UVMHN was "demanding" more than a 15% price hike in one year.

"Agreeing to the health system's demands would mean the cost of care at its flagship hospital − UVM Medical Center − would have increased by more than 35% since 2020," UnitedHealthcare said.

The insurer added that the "continued price hikes" by UVMHN are "not affordable or sustainable" for the people and employers of Vermont and New York. UnitedHealthcare also provided insurance for the health network's hospitals in upstate New York.

Regulator still hoping for an agreement

UVM Health Network pointed out in its news release that UnitedHealthcare is "one of the nation's largest for-profit insurers," and contrasted the insurance company's financial condition with that of the health network, which reported a $90 million loss for fiscal year 2022.

The emergency room at the University of Vermont Medical Center.
The emergency room at the University of Vermont Medical Center.

"In contrast, UnitedHealthcare reported revenue growth of nearly 12% year over year, to $249.7 billion in 2022," the news release stated. "United Healthcare's operating earnings alone (one way of describing profits) were $14 billion in 2022, dwarfing the $3.1 billion total required annually to operate the entire UVM Health Network in Vermont and northern New York."

UnitedHealthcare responded by asserting UVMHN has used its "market dominance" to drive up prices in Vermont and upstate New York.

"The cost of care at UVM Medical Center is more than 20% higher than the average cost at another in-network academic medical center providing similar services less than 90 miles away," UnitedHealthcare said.

Gaffney said he still believes there could be an agreement between the UVM Health Network and UnitedHealthcare.

"We're still hopeful and encourage both parties to come to a resolution," he said. "That would be the most efficient outcome."

Contact Dan D’Ambrosio at 660-1841 or ddambrosio@freepressmedia.com. Follow him on Twitter @DanDambrosioVT. This coverage is only possible with support from our readers.

This article originally appeared on Burlington Free Press: UnitedHealthcare required to continue coverage for some Vermonters