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Hopkins sues insurer over exchange plans

Complaint says exclusion violates 1997 contract

Johns Hopkins Medicine issued a public warning to consumers on Thursday that its hospitals and providers are not covered by some UnitedHealthcare insurance plans sold on the state’s health exchange.

But, without fanfare, Hopkins also took UnitedHealthcare to court that same day. Its lawsuit alleges that three new plans offered through the health exchange breach its 17-year-old contract with the insurance provider.

“While [the plans] may benefit United, they have very serious and expensive potential adverse consequences for patients, Members and for Johns Hopkins,” according to the complaint filed in Baltimore City Circuit Court.

Ben Goldstein, a spokesman for UnitedHealthcare, said the company does not comment on pending litigation.

Open enrollment in the health exchange began Saturday for consumers who attended an enrollment fair in Glen Burnie. The Maryland Health Connection website is scheduled to open to the public on Wednesday.

[UPDATED, Nov. 17 at 12:30 p.m.: Patricia MC Brown, Hopkins’ vice president for managed care and population health, said in an emailed statement the timing of the lawsuit was based on “United’s conduct.” The insurance carrier told Hopkins that its new plans would not cover Hopkins’ hospitals and physicians as of Nov. 10, she said.

“We therefore filed suit promptly after the effective date of the notice,” she said. “In addition, we promptly notified patients/consumers, as they should have the facts before making open enrollment decisions.”]

Hopkins’ press release says UnitedHealthcare’s Compass, Navigate and Core plans will not allow policyholders to use Hopkins’ hospitals — including the Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital and Suburban Hospitals — nor its physicians.

Hopkins’ lawsuit alleges the health exchange plans violate a 1997 hospital participation agreement, which entitles Hopkins to participate as a provider “across the entire range of United’s health insurance network benefits contracts.”

UnitedHealthcare proposed an amendment to the contract in May, asking Hopkins to agree it would be excluded from the health exchange plans, according to the lawsuit. Hopkins refused, but in October, UnitedHealthcare informed Hopkins the health system would not be participating in the plans as of Nov. 10, according to the lawsuit.

Should UnitedHealthcare succeed, Hopkins will suffer “harm, injury and damage,” the complaint states, including not being able to collect unpaid balances from patients.

“Johns Hopkins will be required to provide certain services and will be prohibited from providing others, undermining the negotiated arrangement between the parties,” the complaint states. “In addition, Johns Hopkins’ reputation and goodwill will be impaired and adversely affected.”

Hopkins’ lawsuit also accuses UnitedHealthcare of potentially misleading or confusing the public by refusing to label the health exchange plans as “narrow” — meaning it will not advertise that Johns Hopkins is excluded from the plans.

The lawsuit seeks damages of at least $75,000 for the breach of contract, in addition to asking the court to force UnitedHealthcare to include Hopkins in its health exchange plans.

Kim Hoppe, a spokeswoman for Hopkins, told The Daily Record on Thursday that UnitedHealthcare was the only insurance carrier excluding Hopkins on the health exchange.

Scott Graham, a spokesman for CareFirst BlueCross BlueShield, said the company has not narrowed the networks for any of its plans sold on the exchange, and that about 45,000 health care providers are in the network.

“Our products on the exchange are served by the same networks that serve our off-exchange business,” he said.

The case is Johns Hopkins HealthCare LLC v. United HealthCare of the Mid-Atlantic Inc., Baltimore City Circuit Court Case No. 24C14006409.

Daily Record Business Reporter Alissa Gulin contributed to this story.