Health: Insurance Dispute in Vermont Comes Down to the Wire

The Story:

In late March, thousands of people in Vermont suddenly learned that they were in danger of losing their access to health care, as the consequence of a contract dispute between the country’s largest health insurer, United Healthcare, and the state’s largest health care provider, the University of Vermont Health Network. The two institutions were playing what one might fairly call a game of contractual “chicken.”


United Healthcare covers 5,000 residents of Vermont who receive care from the UVM network. The two parties have been engaged in a dispute over the fees that the former pays the latter. Had they failed to reach an agreement, United Healthcare was prepared to stop treating UVM as an in-network provider.

There are limits as to what the state can do. The state has an exchange under the Obamacare system, the Vermont Health Connect. It also has a regulator, the Green Mountain Care Board, with oversight over hospital budgets and the fees they charge. But it does not have any jurisdiction over UnitedHealthcare’s employer-provided plans, which are federally regulated.

In Pill Form:

Fortunately, the two parties did reach an agreement before the clock ran out on UVM’s status as an in-network provider. With some state mediation, they agreed ‘in principle’ about the fee dispute, although it appears there are still details to be hashed out. Nonetheless, the insurer extended UVM’s existing contract until the end of April so that it will likely be finalized over the coming weeks without disrupting the lives of thousands of patients.




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