The Case Of The Missing Health Care Providers

Southwest Georgia Regional Medical Center in Cuthbert, GA, closed in 2020. (AP Photo/Jeff Amy)

For the past 24 years, Sarah has operated a physical therapy clinic in a small town in Boulder County, Colorado. Her clinic is in-network with health insurance giant UnitedHealthcare, though Sarah's reimbursement rate paid by the insurer for each patient visit has not increased once over the past quarter century. Meanwhile, the cost of running a business has skyrocketed.

Earlier this year, Sarah, who requested anonymity for fear of retaliation, asked the insurer for a raise. She was told there are plenty of in-network physical therapists in the area and therefore there's no need for UnitedHealthcare (UHC) to increase her reimbursement rate. 

In an email, her contract manager told her that the insurer's Boulder County outpatient therapy network “is robust and capable of handling therapy care needs of our UHC patient population” and that “we are under tremendous…pressures not to increase market rates in counties such as Boulder and surrounding areas when we do not have access to care concerns/needs.”

This sounded dubious to Sarah, who is the closest in-network physical therapist for people in many of the surrounding rural mountain towns, so she decided to examine UHC's local directory of in-network providers.

Click here to read the full article originally published January 2, 2024 by The Lever.



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