Wellmont Rejects Unacceptable Contract Proposal From United Healthcare Medicare Plans

Because of an unacceptable contract proposal from United Healthcare, Wellmont Health System patients covered by four United Healthcare plans face the potential of paying higher hospital rates and having limited access to hospitals where their physicians practice after Sept. 30.

To continue receiving in-network rates at Wellmont hospitals, patients will need to obtain coverage from another insurance carrier. Patients who would like to retain in-network rates at Wellmont hospitals can switch from one of the United Healthcare plans to BlueCross BlueShield of Tennessee Blue Advantage, Humana, Windsor Health Plan or the federal government's traditional Medicare program.

Alice Pope, Wellmont's chief financial officer, said United Healthcare proposed terms in a new contract that will not allow Wellmont to be sufficiently reimbursed for costs incurred for care in its hospitals. She said Wellmont would sustain a financial loss if the latest contract proposal from United Healthcare were accepted.

"There are many very good options for patients that will allow them to use the doctors and hospitals they prefer," Pope said. "During this period of transition, our co-workers will be happy to help you navigate this change in a manner that meets your needs. The process is easier than ever."

As a result of United Healthcare's unreasonable proposal, Wellmont will be out of network with that insurance company's four plans, effective Oct. 1. They are AARP Medicare Complete Essential, AARP Medicare Complete Plan 2, AARP Medicare Complete Plus Plan 1 and United Healthcare Dual Complete.

"Wellmont has negotiated in good faith in an effort to reach agreement on a new contract without a disruption for our patients," Pope said. "Unfortunately, the result is an unacceptable contract proposal from United Healthcare that does not come close to matching the reasonable amount other insurance carriers pay our health system."

Pope said the contract proposal Wellmont received might be good business for a for-profit company such as United Healthcare, but she said it performed a disservice to Northeast Tennessee and Southwest Virginia.

"As a not-for-profit health system, Wellmont has been focused on providing superior care at the lowest possible cost," she said. "We have always provided a value proposition that has greatly assisted businesses, insurance companies and individuals in our region. To meet the needs of patients we are privileged to serve, though, we need to be fairly reimbursed, and that would not be the case with this contract proposal from United Healthcare."

Pope emphasized that patients who choose to remain with one of the United Healthcare plans will still be able to access Wellmont facilities for emergency services at in-network rates. Plus, physicians who are in network and practice at Wellmont hospitals can request that this status be granted to their patients.

Medicare requires the granting of this authorization at a physician's request, but only under certain circumstances.

Wellmont's decision not to accept United Healthcare's unsatisfactory contract proposal for the hospitals does not impact other plans it has with this insurance company. It also does not affect contracts Wellmont Medical Associates and the Wellmont CVA Heart Institute have with United Healthcare.

Patients who have questions may call a Wellmont representative at 800-844-2136.