The human cost of contract disputes in health care

In my work as a state senator, I have received numerous calls from patients and their families, expressing concerns that are all too common today. They’re experiencing anxiety, confusion and frustration after learning they can no longer continue seeing their trusted physicians from their health care providers.

These abrupt changes have caused sleepless nights and significant stress for hundreds of people in our region — and has a potentially disastrous impact on public health.

I recently had an extensive conversation with one of my constituents. She wanted to remain anonymous, so I will refer to her as Diana. She is a retiree in her early 70s, suffering from a debilitating and potentially life-threatening autoimmune disease. For more than a decade, she has been under the meticulous care of her physician at Trinity Health. Due to the complexity of her condition and her sensitivity to various medications, maintaining care of her health has been challenging, with countless hours of tests, treatments, and authorizations.

Diana’s health has finally improved thanks to a specific medication, which could not have been found to treat her without the unwavering efforts of her health care team. However, just after achieving this breakthrough, she recently received a letter stating she could no longer see those responsible for it; her insurance with UnitedHealthcare would no longer cover Trinity Health providers. Since I first began working on this commentary piece, the parties involved have reached a settlement, but that is too little, too late for Diana. Her fragile health has been upended by the cumbersome process of securing approvals for her treatments.

In her attempt to navigate this change, Diana called the UnitedHealthcare helpline, only to be met with an inefficient automated system and hours of frustrating conversations. Despite her persistence, she was ultimately told that finding a new physician and transferring her medical records was her responsibility. This experience left her feeling abandoned and overwhelmed, especially since her life-saving medication might no longer be covered if she could not find proper care and coverage.

Once Diana found a new specialist, she found that she cannot see that specialist for several months due to backlogs in scheduling. In the meantime, she is left struggling to manage her complex health conditions. Diana is also not sure that with her ten years of multifaceted care history that a new team will be able to meet the demands of her conditions. She built a trusting relationship with her doctor only for it to become inaccessible, due to reasons that weren’t her fault.

Diana’s plight is not unique. Many patients like her are caught in the crossfire of contract disputes between health care providers and insurance companies. According to a 2023 study, more than half of patients have experienced delays in treatment due to their insurance providers, which has negatively impacted their health. Company negotiations often disregard the human lives affected by their outcomes, leaving patients relying on consistent and familiar care to bear the brunt of these disruptions.

It’s imperative that we establish laws to protect patients during coverage transitions. If a contract between an insurance company and a health care provider is terminated, patients should have the right to switch to other insurance plans maintaining their current care without incurring additional costs. Otherwise, they suffer for decisions completely unrelated to them. Their medications and treatments should remain uninterrupted, and their out-of-network physicians should receive fair reimbursement to continue providing care.

UnitedHealthcare, known for its profitability and generous executive compensation, must remember its primary obligation is to its policyholders’ health and well-being over its shareholders and directors. While financial performance is important, it should not come at the expense of patient care. Our communities’ health should be the paramount concern, guiding decisions and actions.

In these challenging times, we must prioritize the quality and accessibility of health care. We cannot allow the relentless pursuit of profit to compromise the survival and well-being of our citizens. As we move forward, let us ensure that our health care insurance system is patient-centered, compassionate, and just. Only then can we truly say we are serving our community’s best interests.