Update to Network Agreement with UnitedHealthcare and Wellmont Health System - Medicare Insurance Advisors | Medicare Insurance Advisors

Update to Network Agreement with UnitedHealthcare and Wellmont Health System

At UnitedHealthcare, they are committed to helping their members access the health care services they need by providing a broad network of physicians, hospitals and other health care professionals to meet their individual needs.

While they strive for stability in their network, their relationships with providers occasionally change. They have been working diligently with Wellmont, a health care provider in the Tri-Cities region of Northeast Tennessee and Southwest Virginia, to extend our current contract, which is scheduled to terminate on May 31, 2014. This potential termination would affect:

  • UnitedHealthcare Commercial and Medicare benefit plans.
  • Our Medicare Advantage Dual Special Needs Plan members will also be impacted. While they will continue to have access to Wellmont-affiliated physicians, they will no longer have access to Wellmont hospitals and ancillary facilities.

NOTE: Their TennCare and Medicare supplement members will not be impacted by this termination.

UnitedHealthcare is making every effort to reach an agreement and are committed to working closely with Wellmont as negotiations continue. If they are unable to reach an agreement, Wellmont will no longer participate in their network as of June 1, 2014, which will affect Wellmont hospitals, specialists, primary care physicians, ancillary facilities, and CVA Heart and Cancer Institutes.

Affected Hospitals

  • Bristol Regional Medical Center, Bristol, TN.
  • Holston Valley Medical Center, Kingsport, TN
  • Lonesome Pine Hospital, Big Stone Gap, VA
  • Hancock County Hospital (critical access hospital), Sneedville, TN
  • Hawkins County Memorial Hospital, Rogersville, TN
  • Takoma Regional Hospital, Greeneville, TN
  • Mountain View Regional Medical Center, Norton, VA

Affected Ancillary Facilities

  • Wellmont Hospice
  • Sapling Grove Surgery Center
  • Holston Valley Surgery Center
  • Bristol Surgery Center
  • Holston Valley Imaging Center

Member Impact
UnitedHealthcare understands how unsettling a termination with a network hospital can be for their members. They are making every effort to inform their members of the situation and are committed to helping them understand their options to prevent any potential disruption in their care if the Wellmont contract is terminated.

In accordance with state and federal regulatory requirements, we are in the process of notifying members who have accessed care at a Wellmont facility in the past 12 months – making them aware of the potential termination effective as of June 1, 2014.

If they are not able to reach an agreement with Wellmont, their members can seek care at the following alternative hospitals in the area:

  • Unicoi County Memorial Hospital
  • Laughlin Memorial Hospital
  • Buchanan General Hospital
  • Johnston Memorial Hospital
  • Norton Community Hospital
  • Smyth County Community Hospital
  • Franklin Woods Community Hospital
  • Indian Path Medical Center
  • Johnson County Hospital
  • Russell County Medical Center
  • Sycamore Shoals Hospital
  • Dickenson County Community Hospital
  • Johnson City Medical Center

Please note, Wellmont will remain in the UnitedHealthcare Commercial and Medicare Advantage networks until May 31, 2014, and members should continue to access the hospitals and its affiliated physicians as they normally would until then. If UnitedHealthcare is unable to reach an agreement with Wellmont, members receiving care at a Wellmont facility after May 31, 2014 will be treated as out-of-network or denied if the member does not have out-of-network coverage unless it is approved for one of these exceptions:

  • Care of an emergency illness, injury or condition¬†– Members should go to the nearest hospital regardless of whether it is in or out-of -network. Emergency admissions are always covered as an in-network benefit.
  • Transitional care – If Wellmont no longer participates in the UnitedHealthcare network, and a member is undergoing treatment for an acute condition at a Wellmont facility or received services at a Wellmont facility during the past 12 months, the treating physician or member may request transitional care coverage. If approved, transitional care will allow the member to continue receiving in-network coverage for services provided by Wellmont. Please advise members to refer to the transitional care benefit information in their certificate of coverage or have them contact our Customer Care team.

 

 

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