WVU Medicine Uniontown Hospital and Provider Network in Fayette County have requested to terminate from our Medicare Advantage (“MA”) network.
We have been negotiating to limit cost increases for our members and customers and to offer fair and reasonable reimbursement rates, however, WVU Medicine Uniontown Hospital and Provider Network request for additional reimbursement will make it a significant outlier to the rest of our MA network.
Given the gap in rates, we have not been able to reach a sustainable agreement on a new MA contract.
WVU Medicine Uniontown Hospital and Provider Network in Fayette County will continue to be in our commercial networks, but it is unlikely that we will reach agreement before the MA contract terminates on Jan. 1, 2025.
Q: Why is WVU Medicine Uniontown Hospital and Provider Network leaving your Medicare Advantage networks?
A: WVU Medicine Uniontown Hospital and Provider Network in Fayette County have requested to terminate from our MA network.
We have been negotiating to limit cost increases for our members and customers and to fair and reasonable reimbursement rates but have not been able to reach an agreement on a new MA contract.
We are continuing to negotiate on behalf of our MA members for continued access to affordable care, but if we are not able to agree on a new contract, they have asked to terminate from our MA networks effective Jan. 1, 2025.
Q: When will WVU Medicine Uniontown Hospital and Provider Network be considered out-of-network (OON)?
A: The termination effective date is Jan 1, 2025. This is applicable to MA lines of business only.
MA members will have access to the hospital at an in-network rate through June 30, 2025.
There is no extension period for continued in-network (INN) levels of care from the physician practices. The last day for physician INN care is Dec. 31, 2024.
Q: How many members are affected?
A: Approximately 2,500 MA members have used services in the last year.
Q: When and how will you be notifying members?
A: We will be sending letters around Nov. 7, 2024 to align with AEP for all members who have utilized the services in the past 12 months. These letters will provide information on how to apply for continuity of care and how to find other INN providers. Highmark reserves the right to adjust this communication plan as needed.
If you would like to communicate to your clients about this change, you may utilize this email template. Simply copy the body of the email, update the date and greeting, and add your information for the signature.
Q: Will members lose access to services in that area?
A: Our MA network will continue to meet CMS-the federal agency that oversees Medicare-adequacy and access standards even if they leave our MA network.
Q: Does this mean that MA members in Fayette County should look for other coverage for 2025 during AEP?
A: Highmark will continue to have a robust network of facilities in the Fayette County region without WVU Medicine Uniontown Hospital and Provider Network in Fayette County. MA members are encouraged to call the number on the back of their ID card or use Highmark’s online provider directory to find alternative, in-network facilities.
Q: Do Medicare Advantage plans offer OON benefits? If so, how can members learn more about their out-of-network plan design?
A: Although many products offer OON benefits, every policy is subject to specific coverage provisions and limitations and should be researched accordingly before providing a benefit quote.
We understand this news may be concerning, and we are committed to keeping you informed throughout this process.
The information on this website is for agent use only and not intended for the general public.
