Tens of thousands of patients are facing uncertainty following the breakdown of negotiations between Johns Hopkins Medicine and UnitedHealthcare, which ended without the establishment of a new contract. As a result, providers at Johns Hopkins will remain out-of-network for patients who are covered by UnitedHealthcare.
Patients have described the transition as not only stressful but also daunting, as they are compelled to navigate the complex process of finding new doctors whom they can trust. For Lisa Robinson, a patient who received a liver transplant at Johns Hopkins, this situation is particularly worrying. Initially, she was being treated at the University of Maryland Medical Center but switched to Hopkins at the recommendation of UnitedHealthcare, only to later face complications with insurance coverage. Robinson underwent her transplant on August 6 and only learned shortly thereafter about the contractual dispute between Hopkins and UnitedHealthcare.
Now, Robinson is grappling with how to manage her ongoing post-transplant care. Initially, her doctors advised her to stay with them for at least a year following the procedure. She has received approval for continued care through November 11 but is concerned about the future. “Right now, my kidneys are fighting with some of the drugs that are actually helping my liver,” she explained, noting that her medical team needs to regularly adjust her medication based on her health metrics.
Since August 25, Hopkins providers have been officially categorized as out-of-network for United patients, which has also affected residents in Washington, D.C., and Virginia. The two sides have publicly attributed the breakdown in negotiations to conflicting priorities. Johns Hopkins has claimed that disagreements over pre-authorization processes and care denials hinder patient care, while UnitedHealthcare has asserted that Hopkins sought provisions that would allow exclusion of certain employer plans.
The situation is creating a wave of anxiety among other patients as well. Sarah and Zack Smith, who have been frequent visitors to Hopkins for over a year due to their son’s medical condition, expressed their dismay. They had even relocated to Baltimore temporarily while their son was in the neonatal intensive care unit (NICU). Sarah Smith said, “I know that all of our doctors and everyone we’d interact with… wants a solution, but they can’t do anything. We can’t do anything. So, it’s been extremely stressful. It kind of feels like a safety net is being taken away a little bit.”
In an attempt to provide clarity, Hopkins has communicated in a letter to patients that the door for future negotiations with United remains open. The Smiths are hopeful for a resolution, but they are also considering switching to different providers—a move that would entail significant financial implications. Zack Smith acknowledged that bills could skyrocket, illustrating the stark difference in costs with potential out-of-network care. They are also exploring a provider located in Philadelphia, which would add extra travel time to their already challenging circumstances.
In a bid to lessen the impact of the situation, UnitedHealthcare has stated it is working on prioritizing the approval of continued care at Johns Hopkins for eligible patients. Additionally, Hopkins has urged patients to consider alternative insurance options during the upcoming open enrollment season as they face a health care landscape increasingly filled with uncertainty.
