Amy Frank spent 17 hours on the phone over nearly three weeks. She was trying to confirm that her insurer would cover her husband’s care after surgery. The hospital told her to call the insurer. The insurer told her to have the hospital fax a form to a special number. The hospital said it had been told to use a different number. “It was just a big loophole we were caught in, going around and around,” she said.
The Franks were among 90,000 central Missouri patients caught when the University of Missouri’s MU Health Care and the insurer Anthem let their contract expire in April 2025. Allen Frank had fallen off the roof of their home in Rich Fountain, Missouri, and was recovering from collarbone surgery. He needed follow-up care and a second operation. For three months, patients on Anthem plans lost in-network coverage with the region’s largest medical provider, and for some specialties its only one.
Patients as leverage
Most people could not switch plans midyear. They could pay more up front, delay care, find new doctors, or work through paperwork in the hope of qualifying for a 90-day coverage extension. When Allen Frank turned up for an injection in his shoulder, the hospital had no record of the insurer’s approval. He refused to leave without being seen, and a nurse finally got through to Anthem for a confirmation number.
Anthem said the hospital wanted a 39% rate increase over three years. The hospital said the insurer would not go past 1% to 2%. A hearing before the Missouri Senate Insurance and Banking Committee on June 30 broke the deadlock and brought new proposals from Anthem, and a deal followed a week later, retroactive to April 1. “So you put everybody through all of this for nothing?” Amy Frank said the day after it was announced.
Missouri was no outlier. Talks between UnitedHealthcare and Memorial Sloan Kettering Cancer Center in New York missed a June 30 deadline and left some patients in limbo for a day. Duke Health warned it could leave Aetna’s network. In North Carolina, UNC Health dropped Cigna in early December, leaving 65,000 patients without coverage. Penelope Gatlin was told to pay $450 before her 13-year-old son, who has an ultrarare genetic disorder and needs IV infusions every few weeks, could see his rheumatologist. A scheduler told her the system was “deprioritizing” out-of-network patients when she tried to book his neurologist. “My kid’s having seizures,” she said she told them. “What am I supposed to do?” UNC and Cigna reached a new deal 12 days after the contract expired. Gatlin’s continuity-of-care approval arrived by mail in mid-January, weeks after that, and was useless by then. UNC refunded the $450 seven weeks later, after she asked.
How common the standoffs are
Jason Buxbaum, a researcher at Brown University, counted documented public brinkmanship at 18% of non-federal hospitals between June 2021 and May 2025, by his preliminary findings. About 8% ultimately went out of network with an insurer at least for a time. Across the same period he found roughly 1,000 public clashes nationwide, and about a third ended with the contract actually expiring. FTI Consulting tallied 83 public disputes in one winter quarter, the most since it began counting in 2022.
“If patients weren’t affected, it wouldn’t work,” Buxbaum said of the tactic.
Consolidation sharpens the fight. More than 2,000 hospital mergers have been announced since 1998, including 428 from 2018 to 2023. “Insurer markets have been consolidated for a long time,” Buxbaum said. “What’s changed is how consolidated the hospital markets have become.” In North Carolina, the number of hospital owners has nearly halved since 2000, to 39.
Costs and the law
Between 1999 and 2024, employee premiums and contributions rose more than 300% while inflation rose 64%. The Kaiser Family Foundation put average annual family premiums for employer plans at nearly $27,000 last year, with workers paying close to $7,000. Hospitals cite inflation, technology, labor and infrastructure costs, plus administrative burdens from insurers. Ben Teicher of the American Hospital Association said those pressures “contribute to instability in hospital-insurer relationships.” Insurers blame hospitals. Peter Daniel of the North Carolina Association of Health Plans called them the biggest driver of rising premiums.
The No Surprises Act, in force since 2022, lets people receiving treatment for serious conditions keep in-network rates for up to 90 days. That is the extension both families chased. Anthem’s parent company, Elevance Health, said it approaches negotiations “with a focus on fairness, transparency, and respect.” MU Health Care said it was sorry for the stress that going out of network caused.
Patients dealing with an ongoing condition should ask their doctor’s office early whether a contract is close to expiring and whether a continuity-of-care request is possible, and consult your doctor about how to keep treatment on schedule.
Sources
- When hospitals and insurers fight, patients get caught in the middle
- Patients Are Caught in Contract Crossfire Between Hospitals and Insurers
