Provider-insurer contract disputes surge amid denials, downcoding.
The article focuses on the escalating contract disputes between health insurers and health system networks amid financial pressures such as cost inflation, labor shortages, and regulatory changes. Major entities involved include CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare, Prime Health...
| Publicado en: | Modern Healthcare Vol. 56; no. 4; pp. 22 - 23 |
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| Autor principal: | |
| Formato: | Journal Article |
| Publicado: |
Crain Communications Inc. (MI)
4/13/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=193070061&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 193070061 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01607480 MHL jtl: Modern Healthcare issn: 01607480 maglogo: N pubinfo: dt: 4/13/2026 vid: 56 iid: 4 pid: 778 pub: Crain Communications Inc. (MI) place: Detroit, Michigan artinfo: ui: 193070061 193070061 ppf: 22 ppct: 1 formats: fmt: @attributes: type: T tig: atl: Provider-insurer contract disputes surge amid denials, downcoding. aug: au: Tong, Noah sug: subj: Insurance, Health Insurance Carriers Reimbursement Mechanisms Contracts Dissent and Disputes Insurance Coverage Health Insurance Exchanges Price Transparency Hospitals Federal Government United States Health Care Costs Medicaid Medicare ab: The article focuses on the escalating contract disputes between health insurers and health system networks amid financial pressures such as cost inflation, labor shortages, and regulatory changes. Major entities involved include CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare, Prime Healthcare, and Jefferson Health, with conflicts arising over reimbursement rates, prior authorization requirements, and policy changes. These disputes are intensifying due to shrinking margins for hospitals, increased market consolidation, and the use of price transparency data and artificial intelligence in negotiations. Recent examples include Spartanburg Regional Healthcare System leaving Aetna’s network and ongoing negotiations between University of Michigan Medicine and Blue Cross Blue Shield of Michigan. pubtype: Periodical doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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