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United Healthcare
Providence Anesthesiology Associates is a trusted team of physicians and nurses that has proudly served the community for over 40 years. We are honored to provide the highest quality anesthesia care to every patient, regardless of their insurance coverage, ensuring their safety and comfort during medical procedures.
In 2019, following more than two decades of in-network status, UnitedHealthcare (UHC) abruptly terminated our contract without cause, effective March 1, 2020. Despite our ongoing efforts to negotiate in good faith and regain in-network status, we remain without a network agreement with UHC. Unfortunately, this situation reflects a growing national trend where large insurance companies increasingly employ aggressive tactics that disadvantage independent physician groups. Many of these smaller practices face significant challenges in mounting the resources needed to combat such widespread, systemic issues. A recent Vanity Fair article highlights several of UHC’s business practices.
Click below to read the latest article in the December 2024 issue of
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UHC Patients – Are you fully covered?
The bipartisan No Surprises Act, implemented in 2022, protects patients from unexpected out-of-network billing when they receive care at an in-network facility. Your claim will be processed by UnitedHealthcare according to your in-network benefits.
As part of the No Surprises Act, Providence Anesthesiology Associates will then submit these claims for arbitration in order to receive fair reimbursement for our services. The independent arbitration firms have awarded PAA wins in over 90% of our submitted claims. Importantly, any fees and additional reimbursement from arbitration do not result in any additional patient responsibility.
Self-insured plans with UnitedHealthcare as their third-party administrator (TPA) should contact UnitedHealthcare to understand how arbitration costs are being passed on to them.
Unveiling the Impact of UHC’s Practices
UnitedHealthcare (UHC) has faced growing scrutiny for practices that contributed to 1 in 5 health insurance claims being denied in 2021—affecting policyholders who diligently pay their premiums. With dedicated “denial specialists,” their approach raises critical questions about patient care.
The repercussions extend to physician practices nationwide, many of which are impacted by denied claims and unfavorable contract negotiations. UHC faces numerous lawsuits, highlighting dissatisfaction and alleged misconduct within the healthcare industry.
Notably, the contracts they offer physicians through organizations like PAA often fall significantly below what other insurers offer, with dramatic reductions from previously negotiated rates.
To understand the broader implications of UHC’s practices, explore the following resources:
UnitedHealth Group Abuse Tracker
Video: UHC’s Strategy Explained
Stay informed and advocate for transparency and fairness in healthcare.
Important Information For Self-Insured Group Health Plans
The No Surprises Act introduced Independent Dispute Resolution (IDR) as a platform for healthcare practices and insurance companies to engage in arbitration to determine fair reimbursement for out-of-network claims. Congress intended for this arbitration process to naturally lead into in-network agreements based on the neutral arbiters’ rulings.
Unfortunately, this has not been occurring. Why is this the case?
Insurance companies are passing on the majority of these significant arbitration costs to self-insured group health plans – in other words, employers are bearing the financial consequences and many are unaware. These self-insured group health plans account for 77% of all claims in IDR.
This situation reduces the incentives for insurance companies to engage in good faith negotiations. In addition, insurance companies have leveraged the complexity and financial cost of IDR to cut reimbursement and terminate network agreements with many independent practices that are unable to successfully navigate it.
According to Centers for Medicare & Medicaid Services, UnitedHealthcare’s claims accounted for 30% of all claims submitted to IDR nationally. Self-insured group health plans with UnitedHealthcare as their third-party administrator (TPA) should request more information about how IDR fees are passed on to them.