Signs of tensions between Carson Tahoe Health and UnitedHealthcare have been apparent for a while.
In November 2023, the Carson City, Nev.-based health system alerted the community that it would terminate its contract with the nation's largest health insurer, a move estimated to affect up to 13,000 people.
"This has a huge negative community impact, a negative financial impact, and a negative patient care impact, but at some point, UnitedHealth has to be held accountable. We are trying to put our patients first," Katie Kucera, vice president and CFO at Carson Tahoe, told Becker's.
By May 30, 2025, patients with commercial and Medicare Advantage coverage from UnitedHealthcare will lose in-network access to the system's two hospitals and provider network that spans 20 locations. Among those patients are many state workers and their dependents, as Carson City is the capital of Nevada, and UnitedHealthcare administers the state's employee health plan.
"It's a really significant impact to our community and not one that we took lightly or just decided for financial reasons," Ms. Kucera said. "There are a ton of barriers with prior authorizations and referrals. And there's been a really big delay in care — then we spend a lot of hours and dollars to get paid what our contracts say."
"This is probably one of the worst situations a CFO can be in. I know this doesn't bode well, but nor does fighting for dollars we're expecting or putting patient care second," she said.
Carson Tahoe, an affiliate of University of Utah Health, noted that care delays among Medicare Advantage patients specifically have been a notable problem. It's a theme echoed by other health systems this year.
"We've had difficult negotiations with UnitedHealthcare over the years and with some other payers, but now it's coming to a head due to the impact of inflation, Medicare Advantage and the pressures on that program, and the fact that we can no longer sustain and accept it," Trinity's senior vice president of payer strategy and product development told Becker's in May.
According to data shared with Becker's by FTI Consulting, there were 20 reimbursement disputes between hospitals and insurers that made headlines somewhere in the country during the second quarter, the same amount as the first quarter and slightly lower than the same period in 2023, when 24 contract disputes were reported in national or local media.
Notably, a record number of Q2 disputes (15 of 20) involved Medicare Advantage plans, and 30% of disputes failed to reach a timely agreement, meaning tens of thousands of patients were left without in-network coverage.
"We've had issues with other payers over the years, but they have all been responsive in a timely fashion and we've found a good middle ground," Ms. Kucera said. "This is the first one that we can't seem to make any movement and we have no sort of say or leverage — we are tiny compared to United."
Ms. Kucera said the contract termination notice issued more than a year in advance is intended to give patients more time to find alternative coverage options.
"We are still having conversations with UnitedHealth, but we are not making any sort of ground," she noted.
"Our goal is to utilize the more than nine months remaining on our contract to engage in good-faith negotiation in an effort to renew our relationship so the people we serve have long-term access to Carson Tahoe Health. We hope they share our commitment toward reaching an agreement," a spokesperson for UnitedHealthcare shared with Becker's.