Here are the ongoing payer-provider contract disputes and splits Becker’s has reported in 2023.
Network exits and splits
Blue Cross Blue Shield of Arizona is out-of-network with Prescott, Ariz.-based Dignity Health Yavapai Regional as of Feb. 8, after the sides were unable to reach a new contract. The payer said the split will affect about 20 percent of its 58,000 beneficiaries in Yavapai County. Emergency care at Yavapai Regional Medical Center will still be covered at in-network rates.
UnitedHealthcare’s Medicaid managed care plan has been out of network with Philadelphia-based Temple Health since Feb. 1, after the two sides were unable to reach a new contract.
Blue Cross Blue Shield of Tennessee’s commercial plans have been out-of-network with Memphis, Tenn.-based Methodist Le Bonheur Healthcare since Dec. 31, 2022. The two sides reached a contract for Medicaid members Feb. 8.
Anthem Blue Cross has been out of network with Clovis, Calif.-based Community Health System since Dec. 31, 2022. The system has negotiated new contracts with Cigna and UnitedHealthcare.
Regence BlueShield of Washington”s Medicare Advantage plans have been out of network with Optum-owned the Polyclinic and Everett Clinic since Dec. 5, 2022. The two sides reached a deal to keep Regence commercial members in network Dec. 22, 2022.
Some Aetna plans will be out of network at UC San Diego Health on April 7 if the two organizations don’t agree on a new contract.
Vanderbilt University Medical Center will drop Humana and Wellcare of Tennessee Medicare Advantage plans effective April 1, over a dispute in reimbursement rates. Spokespeople for Humana and Wellcare told Becker’s the plans hope to reach an agreement with Vanderbilt.
The University of Vermont Health Network will be out of network with UnitedHealthcare’s commercial plans April 1 without a new contract. More than 2,600 employer-sponsored and individual commercial members in Vermont and northern New York will lose coverage for the Burlington-based health system’s hospitals, facilities and physicians.
Anthem Blue Cross Blue Shield and the Christ Hospital, based in Cincinnati, could split if the two sides cannot reach a contract agreement by April 1. According to a statement on the Christ Hospital’s website, the negotiations affect Anthem commercial, Medicare Advantage and Medicaid members.
Empire BlueCross and Ellis Medicine, based in Schenectady, N.Y., will split May 1 unless the two sides can agree to a new contract.Source: BeckersPayer