Trinity 'taking a stand' against UnitedHealthcare

Trinity Health of New England, part of Livonia, Mich.-based Trinity Health, is not budging in its negotiations with UnitedHealthcare over a new contract to replace the current deal that expires at midnight on June 30.

THNE, which comprises three acute care hospitals in Connecticut and one in Massachusetts, said in a statement to Becker's that UnitedHealthcare proposes increases far below the rates of other area payer contract renewals. 

"We are taking a stand now because we must — we can no longer sustain low reimbursement," a spokesperson for THNE said. 

"We are simply asking for fair rates that other payers have agreed to," the health system said. "UnitedHealthcare is making billions, frequently denying, delaying and underpaying claims, and reimbursing at below market rates while patients' out-of-pocket costs continue to increase and not-for-profit providers like us struggle to invest in the medical innovations, technologies and programs our communities depend on."

Both parties have been negotiating terms to renew the contract for THNE's hospitals, facilities and physicians over the past several months. If they cannot agree a deal, the health system will be out of network for Medicare Advantage, Medicaid and employer-sponsored commercial plans, effective July 1. 

The negotiations come at a time when many health systems are seeing patient volumes rebound, which has helped some offset the high costs of labor and supplies. However, many systems are still struggling to improve their operating margins while large commercial payers reported billions in profits in 2023. 

UnitedHealthcare's total earnings from operations increased 14.2% year over year to $16.4 billion in 2023. Its parent company, UnitedHealth Group, reported net earnings of $22.4 billion, up 11.2% year over year.

On the other side of the negotiation table is Trinity Health, a 101-hospital, nonprofit system. It reported $69.8 million in operating income (0.4% margin) for the nine months ending March 31, compared to a $263.1 million operating loss (-1.6% margin) for the prior-year period. 

"We've dealt with UnitedHealthcare's forceful negotiations and low rates for years because we didn't want to go out of network and disrupt care," a THNE spokesperson said. "The payment we receive from UnitedHealthcare does not appropriately cover the true cost of care we provide, especially given the cost inflation we have experienced, which is why we need a fair rate increase."

THNE is seeking a more than 30% price hike for employer-sponsored commercial plans that would take effect over the next 24 months, a spokesperson for UnitedHealthcare said in a statement shared with Becker's. The insurer said THNE has demanded "outlandish rate increases" that would significantly drive up healthcare costs in Connecticut and Massachusetts, arguing that the health system's latest demands would increase costs by about $33 million for people enrolled in UnitedHealthcare's employer-sponsored commercial plans.

THNE claims that UnitedHealthcare is misrepresenting the situation and "not putting patients first."

In a message posted to its website, the health system said it wants "new agreements that more adequately cover the cost of the care we provide to our patients with UnitedHealthcare commercial and Medicare Advantage plans."

"They continue to not reimburse us fairly and deny or underpay claims, so they can use those dollars to bolster their own pockets and those of their shareholders," according to the health system. "Health insurers, including UnitedHealthcare, are posting record-breaking profits for shareholders, while we are expected to cover gaps. We cannot continue to do more with less."

THNE also fought publicly over a contract with Cigna earlier this year before reaching a new multiyear deal in February, but it is not the only health system that is taking a tougher stance on contract renewals with payers. 

Chicago-based CommonSpirit said it is also pushing for change in the dynamics of payer-provider relationships and is drawing a hard line on contract renewals "so payers absorb a share of inflation." 

Eleven of CommonSpirit's hospitals in Colorado went out of network for more than two weeks with Anthem Blue Cross Blue Shield of Colorado. The system said it made the decision after Anthem BCBS "failed to offer terms that fairly reimburse for services provided to its members, and equitably cover the burden to get reimbursed timely and accurately." 

CommonSpirit and Anthem BCBS on May 17 reached a five-year agreement, which is retroactive to May 1, when the previous contract expired. The agreement covers commercial, Medicare Advantage and individual plans. 

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