Sparks physicians are ‘out-of-network’ with UnitedHealthcare, hospital could be by Nov. 1 (Updated)

by Aric Mitchell ([email protected]) 959 views 

Editor’s note: Story updated to reflect that Sparks physicians are already out of network with United, with the hospital possibly being out of network by Nov. 1.
Sparks Clinic and UnitedHealthcare Insurance have reached a standstill in network contract negotiations, resulting in approximately 8,000 patients in the Fort Smith area with physicians who have moved to “out-of-network” status.

Failure to compromise has impacted UnitedHealthcare commercial (employer-sponsored), individual, and Medicare Advantage health plans. Sparks Clinic has 91 providers, which includes physicians, advanced practice nurses, and physicians’ assistants.

In a press release on Tuesday (Aug. 1), Dan McKay, CEO of Sparks Health System, said the organization is “working with patients, physicians, employers and other members of our community to help them understand what this means if they have United coverage.”

“Although we’ve made many attempts to find resolution with United, we continue to try to reach an agreement so our patients can again have in-network benefits with the Sparks physicians they trust and to restore a collaborative relationship with United.”

In a follow-up statement to Talk Business & Politics on Wednesday (Aug. 2), Sparks said UnitedHealthcare “has been leading our patients to believe that we would not become out of network,” adding “the truth is, we remain far apart on key aspects of a new contract, and now face the possibility that our hospitals and other facilities will become out-of-network providers on Nov. 1, 2017.”

This excludes Sparks Medical Center-Van Buren, which has been out-of-network with United since May 15, 2017.

“We are disappointed in United’s unwillingness to compromise on an agreement that would allow our physicians to remain in-network. However, we will continue to do all that we can to reach resolution, so that our patients can have restored in-network benefits with the physicians they know and trust. Patients are encouraged to visit to find out if their physician is affected and to learn more about what they can do,” the statement concluded.

A statement from UnitedHealthcare spokesperson Cole Manbeck provided Wednesday to Talk Business & Politics had a different view on the failure to compromise. Manbeck said Sparks Clinic had “not yet renewed its participation in UnitedHealthcare’s network despite the multiple offers we have made, which included a multi-month extension to the current contract. However, UnitedHealthcare continues to pursue an agreement in an effort to avoid disrupting UnitedHealthcare members’ access to their physicians.”

Sparks Clinic is a Community Health Systems (CHS)-owned physician group that participates in an independent practice association called PremierCare of Northwest Arkansas IPA, which terminated its agreement with UnitedHealthcare, effective Aug. 1. The IPA is a subsidiary of CHS. Membership in PremierCare includes CHS-owned physician groups and independent community physicians in Northwest Arkansas.

According to Manbeck, “We offered direct contracts to all physician groups affiliated with the IPA, which would ensure UnitedHealthcare members continued access to care with their physicians under their UnitedHealthcare benefit plan at no additional cost. Fortunately, more than 75% of the physician groups participating in the IPA have signed new, direct contracts with UnitedHealthcare, avoiding any disruption for their patients. We continue to receive additional direct contracts daily from physician groups associated with the IPA.”

Manbeck continued: “We are fortunate to have relationships with many other physicians in the area to ensure the UnitedHealthcare members we serve have access to the care they need. For information regarding other in-network physicians, members should call the number on their health plan ID card.”

According to its website, the UnitedHealthcare network “includes all the health care providers who work with your insurance company to care for health plan members like you. Your insurance company has agreed to pay those health care providers a certain amount of money for your visits — usually a discounted rate. Because of those discounts, you pay less when you see a health care provider in the network versus one who’s outside the network. For out-of-network providers, your insurance may cover only a fraction of the cost of care — or none at all — depending on your plan.”

As the two sides continue to hold their positions, Sparks is advising patients in need to “go to the nearest emergency room.”

“Access to emergency care is not impacted, regardless of our network status with United,” the company stated. “If a patient’s health insurance plan has out-of-network benefits, their care may still be covered with our physicians. We encourage patients to call the number on the back of their United insurance card to find out if they qualify, and what their out-of-pocket costs may be.”

Patients are also advised to consult their United cards if they are pregnant or undergoing treatment for an ongoing condition, because they may qualify for “Continuity of Care,” which would allow a patient to “continue their current course of care with their physician as in-network.”