Envision Healthcare's 25,000 clinicians are no longer considered in-network with UnitedHealthcare, the nation's largest private payer, the physician staffing company confirmed Tuesday.
The nationwide contract dispute threatens to leave patients with higher costs and surprise bills as Envision clinicians staff many hospitals, including emergency rooms across the country. Envision clinicians work in 44 states and D.C.
Envision claims UnitedHealthcare "refuses to keep" its clinicians in network and "decided not to renew its longstanding partnership with Envision Healthcare in the midst of a national health crisis," according to a recently released statement.
The staffing firm said not all patients may be protected by UnitedHealthcare's cost-sharing waivers for out-of-network, in-patient COVID-19 care.
"United's COVID-19 coverage means that one in 10 patients who go to an emergency room may face a surprise gap in coverage," Envision said in its recent statement.
UnitedHealthcare blamed Envision's high prices and said Envision expects to be paid twice the median rate of other anesthesiologists and more than triple the median rate of other ER physicians.
"Most providers we work with are contracted at fair, market-competitive rates, but a small number of providers, and especially private equity-backed physician staffing companies like Envision, are driving up the cost of care for the people and customers we serve," UnitedHealthcare said in a statement.
The payer said the two began negotiations in May but were ultimately unable to come to an agreement before the first of the year. The majority of Envision physicians now out of network are ER doctors and anesthesiologists, UnitedHealthcare said.
The legislation that bans surprise billing does not go into effect until 2022, and UnitedHealthcare is asking Envision to honor its commitment that it will not surprise bill patients in 2021.
This is not the first time the two have been involved in a contract dispute. In 2018, UnitedHealthcare threatened to drop Envision from its network. At the time, the payer also alleged Envision's rates were responsible for driving up healthcare costs.
The two eventually came to terms, but UnitedHealthcare won by securing "materially lower payment rates for Envision," according to a previous report from S&P Global analysts.
In the years that followed that squabble, the insurer cut, or threatened to terminate, other physician staffing firms from its network in a bid to extract lower prices.
Analysts previously told Healthcare Dive that they expected UnitedHealthcare's squeeze on these firms to continue.
Following the dispute with Envision in 2018, UnitedHealthcare then cut some of its contracts with TeamHealth, which has a special focus on emergency medicine. Again, the insurer pointed to TeamHealth's high prices as a reason for its action, and also pointed the finger at those firms backed by private equity.
Both TeamHealth and Envision are owned by private equity firms.
Last February, UnitedHealth also cut Mednax, another physician staffing firm, from its network in four states over a pricing squabble. Though the payer later said it extended those contracts amid the pandemic.