50,000 Lose LVHN In‑Network Coverage

Lehigh Valley Health Network is now out of network for most UnitedHealthcare commercial plans after the two sides failed to renew their contract by April 26. (lvhn.org) (uhc.com) The change applies to LVHN hospitals, facilities and physicians in the Lehigh Valley that were covered under UnitedHealthcare employer-sponsored commercial plans. LVHN said the contract lapse followed more than two years of negotiations. (lvhn.org) (phillyburbs.com) Local TV station WFMZ reported about 50,000 patients are affected. Those patients can still get care at LVHN, but many will face higher out-of-pocket costs or have to switch providers. (newsbreak.com) (lvhn.org) For patients with UnitedHealthcare PPO plans, LVHN says out-of-network benefits may still apply, but copays, coinsurance, deductibles and out-of-pocket maximums will be higher. For patients with UnitedHealthcare HMO plans, LVHN says there are no out-of-network benefits. (lvhn.org) Both sides blame the other for the breakdown. LVHN, now part of Jefferson Health, said UnitedHealthcare has paid nearly 40% less than expected since 2021 and refused terms that reflect the cost of care. (lehighvalleynews.com) (lvhn.org) UnitedHealthcare says LVHN chose to end the contract and was demanding a one-year price increase of more than 20%. The insurer said its goal was to keep coverage affordable for Pennsylvania families and employers. (uhc.com) (fiercehealthcare.com) This commercial split came after an earlier break on Medicare Advantage. LVHN fell out of UnitedHealthcare’s Medicare Advantage network on Jan. 26, affecting more than 20,000 patients, according to Fierce Healthcare. (fiercehealthcare.com) Some patients in active treatment may qualify for continuity-of-care protections that temporarily preserve in-network coverage. UnitedHealthcare says members must apply, and LVHN says emergency care is still covered. (uhc.com) (lvhn.org) Veterans covered through the UnitedHealthcare Veterans Affairs Community Care Network are not affected by the commercial contract status, according to LVHN. Jefferson Health providers outside the legacy LVHN footprint also remain in network with UnitedHealthcare. (lvhn.org) (fiercehealthcare.com) For Lehigh Valley patients, the contract fight is no longer a warning. As of April 26, network status changed, and the next decision is whether to seek an exception, pay more, or move care elsewhere. (lvhn.org) (uhc.com)