Updated October 2, 2024
WellSpan Health issued a notice to end our current contract and is demanding significant price hikes despite its hospitals already being the highest cost in south-central and eastern Pennsylvania
We are engaged in active negotiation with WellSpan Health regarding our network relationship. Our top priority is to reach an agreement that’s affordable and sustainable for Pennsylvania and Maryland families as well as employers while ensuring continued, uninterrupted network access to the health system.
If we are unable to reach an agreement, WellSpan’s hospitals, facilities and physicians will be out of network for the following UnitedHealthcare plans, effective Nov. 1, 2024:
- Employer-sponsored commercial plans
- Medicaid plans
- Medicare Advantage plans, including*:
- Individual plans
- Group Retiree
- Dual Special Needs Plan (DSNP)
- Institutional Special Needs Plan (ISNP)
*Important note: The majority of WellSpan’s providers currently do not participate in our Medicare Advantage network as of today. The following WellSpan providers would also be out of network if an agreement is not reached prior to Nov. 1:
- WellSpan Medical Group providers in Lancaster County would be out of network for Medicare Advantage individual plans as well as DSNP;
- All WellSpan Medical Group providers participate in ISNP as of today but would be out of network if an agreement is not reached;
- WellSpan Waynesboro and WellSpan Chambersburg hospitals and medical group providers would be out of network for DSNP. These providers do not currently participate in our network for Medicare Advantage individual plans.
- All other WellSpan hospitals, facilities and physician practices not noted above do not currently participate in our Medicare Advantage network and remain out of network as of today.
WellSpan’s rates are egregiously high and are driving up the cost of health care for consumers in the region, yet the health system continues to seek significant rate increases that drive up its already-high costs
WellSpan’s hospitals are more than 30% higher than the average cost of all other hospitals participating in our commercial network in south-central and eastern Pennsylvania.
Despite this, the health system is demanding significant price hikes that drive up health care costs at an unsustainable rate. If we reimbursed WellSpan’s hospitals at the market average of its peers, it would significantly reduce health care costs for Pennsylvania and Maryland families as well as employers, translating into significant cost-savings for self-funded companies as well as lower premiums and out-of-pocket costs for consumers.
We are asking WellSpan to understand its role in the skyrocketing cost of health care and to work with us to ensure quality health care is available at an affordable cost.
York Hospital, WellSpan’s flagship facility, is one of the most expensive hospitals in the state and is significantly higher cost than the top-ranked hospitals in Pennsylvania
York Hospital’s rates are higher than any other hospital in our network in south-central and eastern Pennsylvania. The hospital’s costs are more than 40% higher than the market average.
York Hospital’s costs are more than 50% higher than the average cost at the top five hospitals in U.S. News & World Report’s rankings for best hospitals in the state, despite York Hospital ranking in a tie for the No. 20 facility in Pennsylvania.
Consider the following examples, which compare the costs for just a few common services at WellSpan’s hospitals for UnitedHealthcare members enrolled in employer-sponsored plans to the average cost at other hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an emergency room visit at WellSpan’s hospitals is more than $800 higher on average than other hospitals in our network in the market
- The cost of an emergency room visit to York Hospital is nearly $1,000 higher than the average cost of hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an outpatient surgery at York Hospital is nearly $9,000 more – or more than 60% higher – than the average cost of all other hospitals in our network in south-central and eastern Pennsylvania
- The average cost of an ultrasound and PET scan is more than $250 higher at WellSpan’s hospitals compared to the average cost of other hospitals participating in our network in the area
- The average cost to receive nuclear medicine treatment at York Hospital is more than $1,700 higher – or nearly 50% more – than the average cost of other hospitals in our network in the market
These examples illustrate why we are asking WellSpan to work with us to make health care more affordable for consumers and companies doing business in the region.
Self-funded employers bear the brunt of WellSpan’s high costs. Approximately 70% of UnitedHealthcare members in Pennsylvania and Maryland are enrolled in self-funded plans – meaning their employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims.
When working with self-funded customers, we treat their money as if it were our own. These employer group customers have charged us with the responsibility of providing their employees access to quality, affordable health care.
As the prices for health care continue to rise, less money is available to help grow the business through things like investments in new technologies or salary increases for hard-working employees.
Establishing competitive contracts with physicians and hospitals is critical to our ability to meet our obligations to the self-funded customers we serve. That is why we are focused on reaching a new agreement with WellSpan at rates that are affordable and sustainable for our customers and members.
Our top priority is to reach an agreement with WellSpan while ensuring continued, uninterrupted access to care for the people we serve. We continue to compromise and are proposing a contract that would help ensure the health system is still reimbursed at more than fair and reasonable rates while also helping to slow the unsustainable rise in health care costs.
We also proposed to extend our current contract to allow additional time to continue our discussions without putting our members in the middle of our negotiation. WellSpan rejected our proposal, presumably in an effort to use our members and their patients to pressure us to agree to the price hikes the health system continues to seek.
In the event we do not reach an agreement, people enrolled in our Group Retiree Medicare Advantage PPO plans may still receive care from any WellSpan hospital or physician as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Their share of the cost will be the same as if they were part of the network for some or all services.
UnitedHealthcare Group Retiree Medicare Advantage members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to retiree.uhc.com.
We remain committed to continued good-faith negotiation with the goal of reaching an agreement that’s sustainable for consumers and local employers
We know the relationship people have with their health care providers is not only important; it’s personal. That is why our top priority is to renew our relationship with WellSpan so the people we serve have continued access to the hospitals and physicians they know and trust for their health care needs. We are committed to meeting with the health system as often as it takes to reach a new agreement.
However, should WellSpan choose to leave our network, we have created the following page dedicated to information about continuity of care as well as alternative physicians and hospitals remaining in our network so that our members have the information they need regarding their health care options.