Dive Brief:
- UnitedHealthcare released a scathing statement against John Hopkins Medicine and Capital Women’s Care earlier this week, accusing the providers of hindering contract negotiations by putting business needs above patients’ best interests.
- The statement is an escalation of a growing conflict between the two parties. Both providers went out of network with the insurance giant in August, and Johns Hopkins officially called off contract discussions with UnitedHealthcare in late September — a move that left approximately 60,000 enrollees unable to access care at the health system’s locations throughout Maryland, Virginia and Washington, D.C.
- UnitedHealthcare says the stalemate in negotiations lies at the feet of the providers, claiming Johns Hopkins wants a contract that would allow it to “refuse treatment for any employer it does not want to do business with,” while CWC wants double-digit payment increases for certain services.
Dive Insight:
Although for patients the outcome of both conflicts is the same — confusion about coverage and care access — the disputes at the center of each is different.
The insurer’s dispute with CWC is a familiar story — the women’s healthcare provider wants payment increases for services under commercial, Medicaid, and Medicare Advantage plans. Allegations of inadequate reimbursements have been at the center of contract disputes between payers and providers for years, with providers saying they need higher payments to keep up with the increased cost of providing care.
CWC operates 75 women’s health center locations throughout Maryland, Virginia, and Washington D.C. It says it has experienced increased hurdles and denials to providing care because of UnitedHealthcare’s policies, as well as economic challenges.
“Capital Women’s Care and its practitioners are experiencing the same challenges with inflation and the rising costs of supplies, services, employee benefits and related items that you are feeling,” CWC said in a statement. “Our requested increases have been humble compared to the premium increases employers and members have borne in recent years and are intended to help ensure we can provide the same level of care to patients.”
UnitedHealthcare disputes this, saying the increases would make care at CWC facilities 30% more expensive than the average of other OB/GYN providers in UnitedHealthcare’s Maryland and Virginia commercial network. The insurer says the majority of cost hikes would fall on patients.
Meanwhile, Johns Hopkins asked for the right to refuse treatment for specific employers, according to UnitedHealthcare.
“Imagine showing up at the hospital or clinic and being told that you can’t see your doctor because Johns Hopkins doesn’t want to do business with your employer,” Joseph Ochipinti, UnitedHealthcare’s CEO for the Mid-Atlantic region, wrote in the statement. “A provider that selectively and unilaterally turns patients away — regardless of medical need or coverage — disrupts equitable access to care.”
Johns Hopkins refutes this narrative and says the negotiation breakdowns occurred over the insurers’ practices that created barriers to care, including excessive treatment denials and payment delays.
“This was not about money or small administrative issues,” the system said in a statement in September. “UnitedHealthcare refused to agree to reasonable terms that would ensure you receive the care you need, when you need it, without excessive delays or denials. We could not sign a contract that allows an insurance company to prioritize their profits over our patients’ health.”
Publicizing contract disputes is becoming an increasingly common tactic among both providers and payers, as both attempt to curry favor with patients and pressure the other party to agree to favorable terms.
This year alone, Jefferson Health and Cigna, Broward Health and Florida Blue and Southwestern Health Resources and a Texas Blues plan have duked out contract negotiations in the public eye.
Dozens of other disputes happen in smaller markets around the country, according to an analysis from FTI Consulting, which tracks provider and payer disputes. The consultancy found 55 payer and provider disputes reported in the media during the first two quarters of 2025, a continuation of a trend that has been on the rise over the past several years.
UnitedHealthcare is no stranger to public disputes. In July, roughly 20,000 UnitedHealthcare Rhode Island patients lost access to Brown Health hospitals after the two companies failed to negotiate a new contract.
