Beneficiaries with private or employer-sponsored coverage will have in-network access to Nemours Children’s services beginning Oct. 1, according to hospital officials. Coverage includes services provided by Nemours Children’s-affiliated physicians in Delaware, New Jersey, Pennsylvania and Maryland.
The agreement affects about 240,000 UnitedHealthcare enrollees.
Contract aside, Nemours Children’s plans to move forward with a suit filed against UnitedHealthcare of Delaware in 2015 seeking $15 million in damages for unpaid healthcare services to Medicaid beneficiaries. The suit alleges UnitedHealthcare of Delware’s Medicaid contract with the state was not adequate because it excluded Nemour’s duPontHospital, the only pediatric-focused hospital in the state, from it’s network. As a result, UnitedHealthcare forced Nemour’s duPontHospital to take on millions in uncompensated care costs, the suit argues.
NemoursduPontHospital won settlements against UnitedHealthcare of Pennsylvania, UnitedHealthcare of the Mid-Atlantic and UnitedHealthcare Community Plan of New Jersey in the last five years.
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