Contract dispute between Ascension Wisconsin UnitedHealthcare could force thousands to find new doctors

MILWAUKEE (CBS 58) -- A dispute between a large health system and one of the country's biggest health insurers could leave thousands of people in Wisconsin searching for a new doctor.

Ascension Wisconsin notified patients earlier this month its doctors and hospitals may be considered out-of-network for UnitedHealthcare members starting Wednesday, Oct. 1 if the two sides don't agree on a new contract.

The health system said it has been in negotiations with UnitedHealthcare for months, seeking what it called fair reimbursement rates. Ascension said UnitedHealthcare’s current proposal does not keep up with cost increases hospitals face, including inflation and rising equipment and medication prices.

Ascension's letter to patients, dated September 2, said UnitedHealthcare has "refused to offer rates that reflect today's dramatic financial realities facing health systems."

If no agreement is made, Ascension Wisconsin facilities and doctors will no longer be covered as in-network for UnitedHealthcare Commercial plans.

A spokesperson for UnitedHealthcare said without a new contract, Ascension will no longer be in network for people with either employer-based or individual commercial plans. People with plans through Medicare Advantage would also no longer be in Ascension's network.

"We are actively negotiating in good faith with Ascension Wisconsin and are delivering a new proposal to the health system," UnitedHealthcare Wisconsin CEO Dustin Hinton said Wednesday in a statement.

A spokesperson for the insurance company said they'd offered a contract that pays rates consistent with what other health systems receive.

While the two mega companies go back and forth over numbers, patients like Eulaer Terrell are caught in the middle. Waiting for a bus after leaving an appointment at the Ascension St. Mary's campus on the east side, Terrell said she appreciated being a single bus ride from all her appointments and didn't want that to change.

"It's kind of hard getting to know a new doctor once you got used to the doctor you already have," Terrell said.

Dan Sacks, an associate professor of risk and insurance at UW-Madison, said he expected both sides to reach a deal this month, given the serious impact thousands would feel if there's no new contract.

Sacks said as more hospitals and care providers merge into mega health systems and insurers combine into even larger corporations, both sides have reason to feel more comfortable playing hardball with new contracts.

"All the consolidation gives each side a lot more leverage to drive a hard bargain," Sacks said. "United has a lot of patients it can bring to Ascension, but Ascension is a very important hospital for people living in the area."

Sacks noted any increase in fees insurers face will get passed along to patients through their individual plans or to employers offering health benefits to their workers.

Democratic Sen. Tammy Baldwin told CBS 58 in a statement Wednesday she was aware of the situation and wanted certainty for Ascension patients across the state.

"It’s past time both companies put patients over profits," Baldwin said. "Cut a fair deal, and get Wisconsin families affordable health care.”

CBS 58 also reached out to Republican Sen. Ron Johnson. His office did not respond to a request for comment on the situation Wednesday.

Terrell said she was hopeful the two sides will indeed cut a deal.

"Think about the patients," she said. "Think about how they would feel if they have to go find some new place."

For now, patients may continue visiting Ascension doctors and clinics as usual. More information can be found by clicking here.

The full letter sent to members can be found below: