UnitedHealth Group is warning insurance plan members that they could lose in-network status with their Northwestern physicians after this year.
The insurer and Northwestern Medical Group each said they were trying to hammer out a new contract. Services provided by Northwestern Memorial Healthcare’s seven hospitals are not affected, they said.
“After Jan. 1, 2019, if you choose to continue to receive care from Northwestern Medical Group, you will be considered ‘out of network’ and you will pay higher costs,” the hospital system says on its website. It wouldn’t comment further.
Neither side is commenting on details of the dispute, but they’re likely to focus on coverage areas and reimbursement rates.
“At this time, the details of the negotiation will remain between UnitedHealthcare and Northwestern,” UnitedHealth said in a statement.
The medical group says it comprises more than 1,200 doctors. UnitedHealth did not say how many UnitedHealthcare policyholders could be involved.
In 2016 UnitedHealthcare had 50,072 Illinois members and an 8 percent share of the statewide market, according to the Kaiser Family Foundation. That was close to Aetna’s 9 percent share but a distant third to Blue Cross & Blue Shield parent Health Care Service Corp., which had 66 percent.
The move would affect employer-sponsored, individual and Medicare Advantage health plans, the insurer said. UnitedHealthcare Medicare Advantage Group retirees are not affected, nor are Northwestern Regional Medicine Group, Northwestern Health Care physician group and Kishwaukee Physician Group
Despite Obamacare’s impact on insurers, UnitedHealth’s stock has soared 254 percent during the past five years, compared with a 66 percent gain in the Standard & Poor’s 500 index and a 71 percent rise in the S&P Health Index.
Minnetonka, Minn.-based UnitedHealth reported a 30 percent gain in net income in the first quarter, to $2.83 billion, on a 13 percent rise in revenue, to $5.5 billion. Annual net income for 2019 is projected to hit $14 billion, compared with $9.3 billion last year and $5.7 billion in 2015, according to Bloomberg data.
In May Crain’s reported that UnitedHealth, Humana, Aetna and other insurers that didn’t profitably sell Obamacare plans largely dropped out of the market by last year. That left behind the profitable insurers, but it also meant fewer health plan choices for people in many parts of the country.
“UnitedHealth could drop Northwestern docs from network” originally appeared in Crain’s Chicago Business.