In the midst of a contract dispute between University of Missouri Health Care and Anthem, Amy Frank found herself spending hours on the phone trying to navigate the complexities of her husband’s post-surgery care coverage. The contract had expired in April, leaving 90,000 central Missouri patients, including the Franks, caught in the middle.
Negotiations between health care providers and insurance companies have become increasingly common across the country. In New York City, UnitedHealthcare and Memorial Sloan Kettering Cancer Center recently faced a similar situation, while Duke Health in North Carolina also announced a potential exit from the Aetna network. These disputes are often fueled by rising health care costs, which have been growing at a faster rate than inflation.
Hospital consolidation has been a driving force behind these disputes, as mergers reduce market competition and give hospitals more leverage in negotiations with insurers. The No Surprises Act, which offers protections for patients in the event of a contract dispute, has provided some relief for those facing out-of-network care.
The Franks experienced firsthand the challenges of navigating continuity of care during the contract standoff. Amy worked tirelessly to ensure her husband could continue his treatment with MU Health Care, despite the obstacles presented by the dispute. Eventually, Anthem and MU Health Care reached an agreement, but the process had taken a toll on the Franks.
As health care costs continue to rise and federal spending cuts loom, these contract disputes are likely to become more frequent. Both hospitals and insurers are feeling the financial strain, leading to prolonged negotiations and potential disruptions in care for patients. The Franks’ experience serves as a reminder of the human impact of these disputes and the need for a more sustainable and transparent health care system.
