Updated November 14, 2024
UnitedHealthcare, WellSpan Health reach agreement that ensures long-term access for people enrolled in UnitedHealthcare Medicaid plans, including CHIP, DSNP and ISNP
WellSpan remains out of network for UnitedHealthcare employer-sponsored commercial plans as of Nov. 1, 2024
We recently extended our current contract for Medicaid, Children’s Health Insurance Program (CHIP), Dual Special Needs Plan (DSNP) and Institutionalized Special Needs Plan (ISNP) through Nov. 30, 2024, ensuring continued network access to WellSpan’s providers that currently participate in our network for these plans.
We have also expanded network access for people enrolled in UnitedHealthcare DSNP. Effective Dec. 1, 2024, DSNP members will have network access to all of WellSpan’s hospitals, facilities and its physicians through a new multi-year agreement. We also agreed to a new multi-year contract that ensures continued, long-term access to WellSpan’s hospitals, facilities and its physicians for people enrolled in our UnitedHealthcare Community Plan (Medicaid), including CHIP, as well as INSP.
The majority of WellSpan’s hospitals and facilities do not currently participate in our network for our Medicare Advantage individual plans. Only WellSpan Medical Group providers in Lancaster County are in our network for Medicare Advantage individual plans. However, these providers will also no longer participate in our network for our Medicare Advantage individual plans, effective Dec. 1, 2024.
WellSpan has communicated it will continue to provide care for people enrolled in our Group Retiree Medicare Advantage PPO plans through Dec. 31, 2024. However, it’s important to note that people enrolled in a Medicare Advantage Group Retiree PPO plan can continue to receive care from any out-of-network provider, if they are a Medicare-approved provider that accepts the plan. The member’s share of the cost will be the same as if they were part of the network for some or all services.
UnitedHealthcare Group Retiree Medicare Advantage members are encouraged to speak with their WellSpan provider to confirm whether they’ll agree to continue to see them on and beyond Jan. 1, 2025.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.
WellSpan Health remains out of network for employer-sponsored commercial plans following the health system’s continued demands for unsustainable price hikes
Despite our repeated efforts to compromise, WellSpan Health’s hospitals, facilities and its physicians remain out of network for UnitedHealthcare employer-sponsored commercial plans, as of Nov. 1, 2024.
Our goal has always been to reach an agreement that is affordable for Pennsylvania families and employers while avoiding any disruption to care. All of our proposals throughout the negotiation would have ensured WellSpan Health continued to be reimbursed at more than fair and reasonable rates. We also proposed to WellSpan that we extend our contract, ensuring continued access to the health system for our commercial members while we continue to negotiate. WellSpan declined our proposal.
Unfortunately, WellSpan Health, whose hospitals are more than 30% higher than the average cost of all other hospitals participating in our commercial network in south-central and eastern Pennsylvania, maintained its demands for unsustainable price hikes.
It remains our top priority to eventually reach an agreement that is affordable and restores network access to WellSpan Health, and we will remain at the negotiating table as long as it takes. However, our primary focus at this time is ensuring Pennsylvanians have access to the care they need through either continuity of care or a smooth transition to a new provider, as appropriate.
We have created the following page to ensure our commercial members have the information they need regarding next steps, including continuity of care and how to find another in-network hospital, facility or physician for their health care needs:
WellSpan’s rates are egregiously high and are driving up the cost of health care for consumers in the region, yet the health system continues to seek significant rate increases that drive up its already-high costs
WellSpan’s hospitals are more than 30% higher than the average cost of all other hospitals participating in our commercial network in south-central and eastern Pennsylvania.
Despite this, the health system is demanding significant price hikes that drive up health care costs at an unsustainable rate. If we reimbursed WellSpan’s hospitals at the market average of its peers, it would significantly reduce health care costs for Pennsylvania and Maryland families as well as employers, translating into significant cost-savings for self-funded companies as well as lower premiums and out-of-pocket costs for consumers.
We are asking WellSpan to understand its role in the skyrocketing cost of health care and to work with us to ensure quality health care is available at an affordable cost.
York Hospital, WellSpan’s flagship facility, is one of the most expensive hospitals in the state and is significantly higher cost than the top-ranked hospitals in Pennsylvania
York Hospital’s rates are higher than any other hospital in our network in south-central and eastern Pennsylvania. The hospital’s costs are more than 40% higher than the market average.
York Hospital’s costs are more than 50% higher than the average cost at the top five hospitals in U.S. News & World Report’s rankings for best hospitals in the state, despite York Hospital ranking in a tie for the No. 20 facility in Pennsylvania.
Consider the following examples, which compare the costs for just a few common services at WellSpan’s hospitals for UnitedHealthcare members enrolled in employer-sponsored plans to the average cost at other hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an emergency room visit at WellSpan’s hospitals is more than $800 higher on average than other hospitals in our network in the market
- The cost of an emergency room visit to York Hospital is nearly $1,000 higher than the average cost of hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an outpatient surgery at York Hospital is nearly $9,000 more – or more than 60% higher – than the average cost of all other hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an ultrasound and PET scan is more than $250 higher at WellSpan’s hospitals compared to the average cost of other hospitals participating in our network in the area
- The average cost to receive nuclear medicine treatment at York Hospital is more than $1,700 higher – or nearly 50% more – than the average cost of other hospitals in our network in the market
These examples illustrate why we are asking WellSpan to work with us to make health care more affordable for consumers and companies doing business in the region.
Self-funded employers bear the brunt of WellSpan’s high costs. Approximately 70% of UnitedHealthcare members in Pennsylvania and Maryland are enrolled in self-funded plans – meaning their employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims.
When working with self-funded customers, we treat their money as if it were our own. These employer group customers have charged us with the responsibility of providing their employees access to quality, affordable health care.
As the prices for health care continue to rise, less money is available to help grow the business through things like investments in new technologies or salary increases for hard-working employees.
Establishing competitive contracts with physicians and hospitals is critical to our ability to meet our obligations to the self-funded customers we serve. That is why we are focused on reaching a new agreement with WellSpan at rates that are affordable and sustainable for our customers and members.
People enrolled in our Group Retiree Medicare Advantage PPO plans may still receive care from any WellSpan hospital or physician as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Their share of the cost will be the same as if they were part of the network for some or all services.
UnitedHealthcare Group Retiree Medicare Advantage members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.
We remain committed to continued good-faith negotiation with the goal of eventually reaching an agreement that’s affordable for consumers and local employers and restores network access to WellSpan Health
We know the relationship people have with their health care providers is not only important; it’s personal. That is why it remains our goal to renew our relationship with WellSpan so the people we serve have restored network access to the hospitals and physicians they know and trust for their health care needs. We are committed to meeting with the health system as often as it takes to reach a new agreement.
We have created the following page dedicated to information about continuity of care as well as alternative physicians and hospitals remaining in our network so that our members have the information they need regarding their health care options.