The current payer-provider contract splits and disputes recorded in 2023 are listed below. While Temple Health and Aetna’s Medicaid plans are not in-network with each other, Baton Rouge General is not in-network with Aetna. Cross in Blue With Methodist Le Bonheur Healthcare, Blue Shield of Tennessee is not in-network. The Polyclinic and Everett Clinic are out-of-network with Anthem Blue Cross, and the Polyclinic and Everett Clinic are out-of-network with Regence BlueShield of Washington’s Medicare Advantage plans. Cigna Healthcare, UnitedHealthcare, Premera Blue Cross, and Elevance Health Medicaid plans will all be splitting up shortly.
This list of active payer-provider contract disputes and splits for 2023 includes significant cases involving Aetna, UnitedHealthcare, Blue Cross Blue Shield, Anthem, and Regence BlueShield, as well as impending splits with Cigna, Premera Blue Cross, and Elevance Health.
Becker’s has reported several ongoing payer-provider contract disputes and splits in 2023. Here are the details:
Network Exits and Splits:
- Baton Rouge (La.) General is out-of-network with Aetna. The hospitals have been out of network since November, and the physician clinics went out of network in mid-April.
- Philadelphia-based Temple Health’s Medicaid managed care plan has been out of network with UnitedHealthcare since February 1 due to a failed contract negotiation.
- Memphis, Tenn.-based Methodist Le Bonheur Healthcare has been out-of-network with Blue Cross Blue Shield of Tennessee’s commercial plans since December 31, 2022. However, a contract for Medicaid members was reached on February 8.
- Clovis, Calif.-based Community Health System has been out of network with Anthem Blue Cross since December 31, 2022. The system has managed to negotiate new contracts with Cigna and UnitedHealthcare.
- Regence BlueShield of Washington’s Medicare Advantage plans have been out of network with Optum-owned Polyclinic and Everett Clinic since December 5, 2022. However, a deal was reached on December 22, 2022, to keep Regence commercial members in the network.
Upcoming Splits:
- Cigna Healthcare and Chesapeake (Va.) Regional Medical Center will be out of network starting June 1 for those with employer-sponsored health coverage.
- UnitedHealthcare may go out of network with Phoenix Children’s on June 1 if a new contract agreement cannot be reached.
- Premera Blue Cross may be out-of-network with the University of Washington Medical Center in Seattle starting July 1 if a new contract is not in place. This could affect approximately 175,000 patients, according to UW Medicine, and around 235,000 Premera members.
- Elevance Health’s Medicaid managed care plans may go out of network with Cincinnati-based Bon Secours Mercy Health on July 1 if a new agreement is not reached. This would impact Mercy’s 21 hospitals across Ohio.