Montpelier, VT – UnitedHealthcare (UHC) recently announced termination of its commercial insurance provider network contract with the University of Vermont Health Network.
This contract non-renewal impacts providers and facilities in Vermont and upstate New York, including the University of Vermont Medical Center, Central Vermont Medical Center, Porter Medical Center, Alice Hyde Medical Center, Champlain Valley Physicians Hospital and Elizabethtown Community Hospital and takes effect April 1, 2023 for most affected plans.
As a result, most non-emergency services will no longer be covered as an in-network benefit under commercial UHC plans. Only Commercial UHC plans, such as those provided by employers or purchased directly, are affected by the non-renewal.
The following UHC plans are unaffected by this contract non-renewal:
- Medicare Advantage (including Vermont AARP Medicare Advantage Plans)
- Medicare Supplement (including Vermont AARP Medicare Supplement Plans & United Medicare Supplement Plans)
- Veterans Administration Community Care Network Plans
- United Behavioral Health Plans
- The Empire Plan for New York State Employees
- New York Managed Medicaid Plans
Affected consumers may have continuity of care rights under the federal No Surprises Act. Under the No Surprises Act, when provider or facility ceases to be an in-network provider because of a termination of a contract, health plans must:
- Give timely notice of the termination and right to elect continued transitional care.
- Provide an opportunity (at least 90 days) to notify the plan or issuer of the need for transitional care; and
- Allow continuing care patients to elect to continue to have the same benefits provided, under the same terms and conditions as would have applied under the plan or coverage had the termination not occurred, with respect to the full course of treatment furnished by the provider.
Continuing care patients are defined under federal law as patients undergoing treatment for a serious and complex condition. For example:
- Cancer
- Pregnancy
- End-stage renal disease or other chronic conditions that require specialized medical care over a prolonged period of time
The No Surprises Act prohibits balance billing for out-of-network emergency care and for post-stabilization care until the patient can consent and safely be moved to an in-network facility.
The Department of Financial Regulation is the primary enforcement agency for the No Surprises Act in Vermont. More information about the No Surprises Act and the Department role in enforcing it can be found on this website.
Consumers may contact the Department of Financial Regulation at 800-964-1784 or by email at dfr.insuranceinfo@vermont.gov.
Consumers can also contact the University of Vermont Health Network at 844-886-4325 or UnitedHealthcare at 800-444-6222 for more information about their specific plan or to make continuity of care arrangements.
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