The payer giant is once again facing a dispute over reimbursement issues, this time from Howard Memorial Hospital.
Payer-provider relationships are already strained from the financial pressures coming out of the pandemic. What won't help the cause is the nation's largest health insurer allegedly failing to properly pay a small, nonprofit hospital.
Arkansas-based Howard Memorial Hospital has filed a complaint against UnitedHealthcare's Medicare Advantage program, claiming the insurer underpaid based on their contract, Southwest Arkansas Radio reported.
The hospital's CFO, Bill Craig, alleges that, according to the 31 accounts he analyzed, UnitedHealthcare underpaid by $250,000. Craig also said he's been working with the payer for approximately six months via email and UnitedHealthcare realizes they have been underpaying but hasn't resolved the issue.
The report states that the complaint was filed with the Medicare Part D complaint division on June 12 and that Craig said he would give the division about 45 days before following up and considering further action.
Howard Memorial Hospital's complaint against UnitedHealthcare comes quickly on the heels of another dispute over underpayment the insurer faced in recent months.
In May, UnitedHealthcare was ordered to pay $91.2 million to Envision Healthcare for reducing reimbursement for care provided in 2017 and 2018. An independent three-member panel of the American Arbitration Association ruled that the insurer breached the terms of the contract with the for-profit physician services provider by unilaterally cutting payments for services Envision rendered as an in-network provider.
"This decision sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need," Jim Rechtin, CEO of Envision, said in a press release. "While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel's decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide."
Contract negotiations between payers and providers are already contentious with both sides fighting to claim as much ground as they can.
When one side, particularly the one that often has more leverage, chooses not to honor an agreed-upon contract, it only erodes trust and creates more friction, which ultimately ends up hurting everyone in the healthcare system.
Jay Asser is the CEO editor for HealthLeaders.
KEY TAKEAWAYS
Howard Memorial Hospital in Arkansas has filed a complaint against UnitedHealthcare's Medicare Advantage program for underpaying by $250,000, according to a report by Southwest Arkansas Radio.
The health insurer was just ordered to pay $91.2 million in May for underpayment in a separate dispute with Envision Healthcare.