Important Update: The Baptist Health System and UnitedHealthcare

Update: February 9, 2024

The Baptist Health System and UnitedHealthcare (UMR) completed their network contract negotiations. As a result of the negotiations, all university plan members have access to Baptist’s providers and hospitals in Arkansas, effective immediately.

The agreement includes the application of in-network coverage retroactive to January 1, 2024. UMR has delayed processing some Baptist provider claims pending the renewal, and those claims will now move forward for payment.   

If you have paid out-of-network fees for covered services with Baptist providers from January 1, 2024, to February 9, 2024, those claims may be reimbursed through UMR using the processes described under the January 1, 2024 update.

Letters are being mailed to impacted Medicare-eligible members informing them of UMR's renewed relationship with Baptist, and that its facilities, hospitals and physicians are back in-network.

If you have any questions, please contact UMR.

Update: January 1, 2024

The Baptist Health System and UnitedHealthcare are in ongoing network contract negotiations. At this point the renewal for January 1^st has not been finalized and Baptist facilities and providers are now OON for the university health plan.

As brief background, the university does not own or control provider networks or contracting. Third-party vendors such as United/UMR are evaluated and selected in part on their ability to provide network access at affordable prices. As a self-funded plan with the costs of health services used determining the premium payments required, the university is always focused on access to quality care at the most economical pricing possible. And in the current situation, UnitedHealthcare and Baptist are negotiating pricing that could affect not just the university health plan but also a number of other employer and insured plans in Arkansas.  

We know that Baptist and UnitedHealthcare are working productively to address their various contracting concerns and we remain optimistic that they will find a balance point and reach an agreement soon. However, the university health plan will provide members with opportunities for continued in-network (INN) coverage of services provided at Baptist facilities and with Baptist network physicians. During this period, the health plan will not apply the higher copayments, deductibles, and out-of-pocket maximums associated with out-of-network (OON) care and will continue the member responsibility at the normal INN costs for covered services. Continued INN coverage may apply to a range of services including PCP visits, ongoing maternity care, post-surgical treatments and follow up physician visits, therapy, scheduled surgeries, and other care. If it becomes necessary, the forms included in the sidebar of this page may be completed by patients or by their providers in requesting approval for continued INN coverage.

Continuity of Care: For members in ongoing treatment with a provider in a situation such as post-surgical therapy or follow up care

• Members should provide the attached Continuity of Care form to their provider.
• If the provider will sign the form, UMR will process the claim as INN for the member and will reimburse the provider at an agreed reimbursement rate.
• If the provider will not sign the form but will file the claim to UMR – UMR will pay the claim as billed and the provider will then reimburse the member.
• Alternatively, if the provider will not sign the form and charges the member for 100% of the bill, the member will submit the billing to UMR for direct reimbursement (less the normal INN OOP expenses).
• Approved Continuity of Care will be honored through completion of the treatment period (childbirth, surgery with follow up office visits, etc).

90-Day GAP Exception: For continuation with a Baptist provider because no other access is available in the time requested, as in a request to continue using a PCP for routine visits

• UMR will process these exceptions as above when the provider submits billing to UMR.
• If the provider charges the member for 100% of the bill, the member will submit the billing to UMR for direct reimbursement (less the normal INN OOP) using the member reimbursement form attached.
• These exceptions will be available for up to 90 days.

Again, Baptist and UnitedHealthcare represent large blocks of participants and providers in Arkansas and we expect that ultimately they will resolve their contracting issues. In the meantime, the university health plan is prepared to continue to treat participants as INN with Baptist for transition of care and continuity of care, assuming Baptist providers and facilities will accept university plan members and of course, in a health emergency all providers are treated as INN for our members.