The human cost of healthcare contract disputes
In my work as a Senator, I have received numerous calls from patients and their families expressing concerns that are all too common today. They are experiencing fear, confusion and frustration after learning that they can no longer see their trusted doctors from their health care providers.
These abrupt changes have caused sleepless nights and significant stress for hundreds of people in our region – and have potentially catastrophic public health implications.
I recently had an extensive conversation with one of my constituents. She wished to remain anonymous, so I will call her Diana. She is a retiree in her early 70s who suffers from a debilitating and potentially life-threatening autoimmune disease. For more than a decade, she has been carefully cared for by her doctor at Trinity Health. Due to the complexity of her condition and her sensitivity to various medications, maintaining her health is challenging, with countless hours of testing, treatments and approvals.
Diana’s health has finally improved thanks to a particular medication that could not be found to treat her without the tireless efforts of her medical team. Shortly after this breakthrough, however, she recently received a letter informing her that she could no longer see those responsible; her insurance with UnitedHealthcare would no longer cover Trinity Health’s services. Since I began working on this commentary, the parties involved have reached an agreement, but that is too little, too late for Diana. Her fragile health has been turned upside down by the arduous process of getting her treatments approved.
To cope with this change, Diana called the UnitedHealthcare hotline, but encountered an inefficient automated system and hours of frustrating conversations. Despite her persistence, she was eventually told that finding a new doctor and transferring her medical records her Responsibility. This experience left her feeling abandoned and overwhelmed, especially since her life-saving medications might no longer be covered if she did not find appropriate care and coverage.
After finding a new specialist, Diana found that she was unable to see him for several months due to overbooking. In the meantime, she is struggling with her complex health issues. Diana is also unsure whether a new team, with her 10-year, complex treatment history, can meet the demands of her illness. She built a trusting relationship with her doctor, which then became unattainable for reasons that were not her fault.
Diana’s fate is not an isolated case. Many patients like her are caught in the crossfire of contract disputes between healthcare providers and insurance companies. According to a 2023 study, more than half of patients have experienced delays in treatment due to their insurance, negatively impacting their health. Insurance companies’ negotiations often ignore the lives affected by their outcomes, leaving patients who rely on consistent and familiar care to bear the brunt of these disruptions.
It is imperative that we pass laws that protect patients when they switch health plans. When a contract between a health plan and a health care provider is terminated, patients should have the right to switch to other plans while maintaining their current care at no additional cost to them, or face the consequences of decisions that have nothing to do with them. They should continue to receive their medications and treatments, and their out-of-network doctors should be fairly compensated to continue providing care.
UnitedHealthcare, known for its profitability and generous executive compensation, must remember that its primary obligation is the health and well-being of its policyholders, not its shareholders and directors. While financial performance is important, it should not come at the expense of patient care. The health of our communities should be the primary concern and guide decisions and actions.
In these difficult times, we must make the quality and accessibility of healthcare our highest priority. We cannot allow the relentless pursuit of profit to jeopardize the survival and well-being of our citizens. Going forward, let us ensure that our health insurance system is patient-centered, compassionate and equitable. Only then can we truly say that we are acting in the best interests of our community.
