UnitedHealthcare in Contract Negotiations with Envision Healthcare

NRECA has been informed that Envision Healthcare could potentially terminate its PPO network contract with UnitedHealthcare (UHC) effective January 1, 2019.

Used by hospitals nationwide, Envision Healthcare is primarily a provider of emergency services that include radiology and anesthesiology.

UHC and Envision Healthcare are currently in contract negotiations.  UHC’s goal is to protect consumers from high costs for emergency services.

As a reminder, under the NRECA Medical Plan  emergencies are paid at an in-network benefit level using the following criteria:

• Out-of-network emergency room doctors are paid at in-network pricing levels when the facility is in-network.
• Out-of-network facilities are paid at the in-network benefit level when the diagnosis qualifies as an actual emergency. This also applies to any surgery performed at that time.
• Radiologists, anesthesiologists, pathologists and labs are always paid at the in-network level when services are rendered at an outpatient or inpatient facility. This benefit applies regardless of the hospital’s or physician’s participating status.

If the negotiations were to continue past the termination date, NRECA has processes in place to minimize participant disruption. For now, Envision Healthcare services are still considered in-network. NRECA will continue to monitor the situation and will keep affected cooperatives apprised of the status of negotiations as additional information becomes available.

If you have any questions, contact your field representative. You also can contact the Member Contact Center at 866.673.2299 or contactcenter@nreca.coop.