Scoop: Charlotte medical provider plans to stop accepting a major health insurance

Scoop: Charlotte medical provider plans to stop accepting a major health insurance
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One of Charlotte’s largest specialty medical providers will stop taking UnitedHealthcare insurance if a dispute over pricing isn’t resolved, leaving thousands of patients in a lurch.

Driving the news: On Feb. 15, Charlotte Eye Ear Nose & Throat Associates, P.A., sent a letter to its patients stating that starting May 15, it will not accept UnitedHealthcare insurance. CEENTA said in the letter that the insurer proposed a reduction in its payments, and that the two sides couldn’t reach an agreement.

  • “In this difficult and fluctuating economic environment for medical practices, supply and staffing costs have risen significantly to the point of impacting current reimbursement levels from insurance providers,” the letter stated.
  • In a follow up statement to Axios, CEENTA said it reached out last fall to UnitedHealthcare for an increase in rates, which haven’t changed since 2017. In response, CEENTA claims it was met with a nearly 20% price cut.

Why it matters: Disagreements over the cost of health care end up costing patients. People covered by UnitedHealthcare will now need to pay out-of-pocket for care at one of the largest multi-speciality practices of its kind on the East Coast, or look elsewhere for services.

  • Around 18,000 people with UnitedHealthcare plans would be potentially impacted, according to UnitedHealthcare spokesperson Cole Manbeck. That’s the number of members who had received services from a CEENTA physician in the last year.
  • UnitedHealthcare insures 1.4 million people in North Carolina, Axios Charlotte previously reported.

Of note: CEENTA offers a range of services, from ear tube surgery for children who suffer recurring ear infections to allergy testing and treatments.

The other side: Manbeck says CEENTA has not countered any of its offers. He says UnitedHealthcare proposed a reduction in reimbursements initially, but has since countered multiple times, and the latest offer, sent before CEENTA’s letter to patients, includes increases.

  • UnitedHealthcare claims that CEENTA’S prices are some of the highest in North Carolina compared to physicians providing similar services, which CEENTA contests. The practice proposed a more than 15% rate increase over the next two years, Manbeck says.

“We have negotiated in good faith and are proposing rate increases to help ensure CEENTA continues to be fairly reimbursed,” he said in an emailed statement.

Yes, but: CEENTA says it has yet to receive a proposal with an increase in rates, but that it is hopeful that the two can come to an agreement.

  • “The decision to announce this change was made in order to give our patients transparency about our recent negotiations with UHC as well as to give any affected patients the necessary time to make needed changes for their upcoming appointments,” the provider said in its statement to Axios.

Context: UnitedHealthcare was also embroiled in a pricing dispute with Providence Anesthesiology Associates, which Novant exclusively works with for anesthesiology services, Axios Charlotte previously reported. That left patients paying out-of-network bills, and ultimately resulted in a class-action lawsuit.

The big picture: Rising health care costs are saddling Americans with debt and bills they can’t afford. Even people with insurance face high out-of-pocket costs. Twenty-nine percent of people with employer-based coverage are underinsured, the New York Times reported based on findings from the Commonwealth Fund.

  • If an agreement isn’t reached, CEENTA will be out-of-network for people with individual, employer-sponsored, Medicare Advantage and Medicaid plans with UnitedHealthcare, Manbeck says.
  • CEENTA has over 150 providers in close to 20 locations across the Carolinas, per its website.
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