UnitedHealthcare knocks Envision radiologists out of its network over ‘egregiously high rates’

The nation’s largest commercial health insurer has decided to cut private equity-backed Envision Healthcare’s radiologists and other physicians out of its health plans, the two revealed recently.

Nashville-based Envision had a “longstanding” agreement with UnitedHealthcare and hoped to strike a deal for 2021. However, the insurer has ended those negotiations, resulting in its 900 radiologists and tens of thousands of other providers now falling outside of UHC’s national network.

“Our healthcare workers risk their lives every day taking care of patients who are fighting for theirs. In the middle of all this, we have United, an insurance and financial services company, that will only keep us in their network if we cut our doctors’ pay,” Doug Smith, MD, president of Envision Physician Services, said in a Dec. 31 statement. “This is wrong. I don’t know what to conclude except United does not value doctors or patients.”

On the other side, UHC said Envision requested payment almost double the insurer’s median rate for anesthesiology and triple the typical reimbursement for emergency physician care.

“Most providers we work with are contracted at fair, market-competitive rates, but a small number of providers, and especially private equity-backed physician staffing companies like Envision, are driving up the cost of care for the people and customers we serve,” UnitedHealthcare Director of Communications Sarah Bearce said in a statement. “While these egregiously high rates help meet the profit expectations of its private equity owner, they also make healthcare less affordable for people across the country.” 

According to Envision, the dispute dates back to at least 2018, when UHC revealed the large gap in their payment negotiations. The physician services firm said it subsequently accepted “significant” rate reductions. However, UHC returned two years later with the aforementioned claim that Envision’s emergency department charges were three times higher than most. Smith and colleagues said they attempted to meet the insurer halfway in negotiations before the talks ended.

“Envision believes the immediate and drastic cuts to clinician pay that United is demanding at this time would be irresponsible,” it said in the statement.

Those involved confirmed that along with anesthesiologists and ED docs, Envision radiologists, neonatologists, hospitalists, and office-based primary care physicians are all no longer part of UHC’s network. The company’s radiologists perform more than 10 million reads for 570-plus facilities, according to its website. All told, the firm employs some 25,000 physicians and advanced-practice providers across 45 states and the District of Columbia.

Private equity firm KKR finalized its purchase of Envision for $10 billion back in 2019.