Amy Frank said it took 17 hours on the phone over nearly three weeks, bouncing between her insurer and her local hospital system, to make sure her plan would cover her husband\u2019s post-surgery care.<\/p>\n
Many of her calls never got past the hold music. When they did, the hospital told her to call her insurer. The insurer told her to have the hospital fax a form to a special number. The hospital responded that they\u2019d been instructed to send faxes to a different number.<\/p>\n
\u201cIt was just a big loophole we were caught in, going around and around,\u201d Frank said.<\/p>\n
Frank and her husband, Allen, faced that ellipse of frustration because they were among 90,000 central Missouri patients caught in the middle of a contract dispute between University of Missouri, or MU, Health Care, a Columbia, Missouri-based health system, and Anthem, the couple\u2019s health insurance provider. The companies let their contract expire in April after failing to strike a deal to keep the hospital system and its clinics in-network.<\/p>\n
A growing number of Americans find themselves in a similar pinch. In New York City, negotiations between UnitedHealthcare and Memorial Sloan Kettering Cancer Center missed a June 30 deadline<\/a>, briefly leaving some patients in limbo until a deal was reached the next day. In North Carolina, Duke Health recently announced it could leave the Aetna network<\/a> unless the insurance company agreed to pay more favorable rates to the health system. And the Franks were nearly caught out-of-network previously, when a 2023 contract dispute<\/a> between Anthem and a primary care group in Jefferson City, Missouri, prompted the couple to switch some providers to MU Health Care.<\/p>\n Indeed, 18% of non-federal hospitals experienced at least one documented case of public brinksmanship with an insurance company from June 2021 to May 2025, according to preliminary findings by Jason Buxbaum, a health policy researcher at the Brown University School of Health. Over the same period, 8% of hospitals ultimately went out-of-network with an insurer, at least for a time.<\/p>\n Industry observers say long-standing trends like hospital consolidation and rising health care costs contribute to the disputes, and Trump administration policies could make them more frequent as hospitals brace for about $1 trillion in cuts to federal health care spending as part of President Donald Trump\u2019s sweeping budget law.<\/p>\n \u201cThey\u2019re going to be more hard-nosed at negotiating with the health plans because they\u2019re going to be in a survival mode,\u201d said John Baackes<\/a>, a retired insurance executive and former board member of America\u2019s Health Insurance Plans, the national trade group representing the health insurance industry.<\/p>\n During the three-month stalemate between the insurer and the health system in Missouri, patients with Anthem plans lost in-network coverage with the region\u2019s largest \u2014 and, for some specialties, only \u2014 medical provider.<\/p>\n Most people were unable to switch insurance midyear and faced the choice of paying higher prices upfront, delaying care, finding new providers, or running a paperwork gauntlet in hopes their medical conditions qualified for a 90-day coverage extension.<\/p>\n The dispute came at a particularly inconvenient time for the Franks. Allen Frank was recovering from complications from falling off the roof while cleaning the siding of the couple\u2019s home in Rich Fountain in October. When it happened, Amy drove him 24 miles to the nearest emergency room. The facility in Jefferson City had recently been taken over by MU Health Care, and Allen was soon transferred 30 miles farther by ground ambulance to the system\u2019s main hospital in Columbia for surgery to insert two metal plates and several screws to repair his collarbone.<\/p>\n Health care consolidation has been booming nationwide for 30 years, with over 2,000 hospital mergers<\/a> announced since 1998, including 428 from 2018 to 2023. Mergers may lead to some efficiencies and benefits for consumers, but they also reduce market competition and strengthen the hand of hospitals in negotiations with insurers.<\/p>\n \u201cInsurer markets have been consolidated for a long time,\u201d Brown\u2019s Buxbaum said. \u201cWhat\u2019s changed is how consolidated the hospital markets have become.\u201d<\/p>\n Now if a hospital system drops out of a network, he said, \u201cit\u2019s not just going to be one key hospital. It\u2019s much more likely to be all the key facilities, or many of the critical mass of providers\u201d in an area.<\/p>\n It\u2019s a scary prospect for patients, making the public threat of a rupture a potent tool in negotiations between hospitals and insurers. That typically works in a hospital\u2019s favor, Baackes said, \u201cbecause the general assumption is the insurance is being greedy and the hospital is doing God\u2019s work.\u201d<\/p>\n In a statement, Buddy Castellano, spokesperson for Anthem\u2019s parent company, Elevance Health, wrote, \u201cWe approach negotiations with a focus on fairness, transparency, and respect for everyone impacted. Health plan rate discussions are complex and require thoughtful collaboration to ensure long-term sustainability. Our commitment remains clear: ensuring access to care while keeping coverage affordable for the families, employers, and communities we serve.\u201d<\/p>\n Allen Frank needed follow-up care in the months after his initial surgery, including a second surgery in July.<\/p>\n A federal law dubbed the No Surprises Act, which took effect in 2022, offers protections for some patients<\/a> whose provider drops out of network due to a contract dispute. People getting treatment for serious conditions can keep their in-network rates for up to 90 days with their current providers, delaying the need to find a new one or face higher rates. So Amy Frank worked the phones to get that continuity of care for her husband.<\/p>\n \u201cOur deductible was already met. If we go out-of-network, we\u2019re going to have to start completely over for the out-of-network deductible,\u201d she said.<\/p>\n Eventually, Anthem agreed to let Allen Frank continue his care with MU Health Care. But when he showed up for an appointment to get an injection in his injured shoulder, he was told the health system didn\u2019t have a record of the approval. He refused to leave without being seen, and, eventually, a nurse was able to get through to Anthem to get a confirmation number and approval for the appointment.<\/p>\n \u201cIt\u2019s just very frustrating,\u201d Amy Frank said in early July, before the sides had reached a deal. \u201cI\u2019ve got my own medical issues, and I don\u2019t feel like mine are bad enough to be fighting for a continuity of care.\u201d<\/p>\n In an email, MU Health Care spokesperson Eric Maze wrote: \u201cWhile our goal was to reach agreement prior to our contract terminating and to avoid disruption in care, we established processes and resources well in advance to facilitate continuity of care and reduce the burden for our patients. We understand and are sorry for the stress and concern being out of network created for many, and we are deeply grateful for the patience and trust placed in us during this time.\u201d<\/p>\n Rising health care costs are fueling contract disputes. Hospital expenses grew 5.1% in 2024, according to a recent brief from the American Hospital Association<\/a>, outpacing the 2.9% inflation rate. Labor costs are the biggest driver, with advertised nursing salaries rising 26.6% faster than inflation from 2020 to 2024, the brief noted.<\/p>\n Hospitals want to recoup those costs by pressing insurance companies to pay more for services.<\/p>\n Washington University in St. Louis health economist Tim McBride said that dynamic could be further enflamed by the massive tax-and-spending law. The measure makes significant cuts to federal health care spending over the next decade, including a $911 billion drop in Medicaid spending, and is expected to cause 10 million Americans to lose their insurance.<\/p>\n As negotiations between MU Health Care and Anthem broke down, the insurer claimed the hospital was seeking a 39% rate increase over three years, while the hospital said the insurer wouldn\u2019t budge past 1%-2%.<\/p>\n On June 30, three months into the standoff, the Missouri Senate Insurance and Banking Committee called the two sides in for a hearing that broke months of deadlock and prompted new proposals from Anthem.<\/p>\n \u201cAnthem doubled their rate increase offer,\u201d Missouri Senate President Cindy O\u2019Laughlin, a Republican whose district includes parts of central Missouri, wrote in a Facebook post<\/a> on July 8, encouraging a deal.<\/p>\n \u201cYes I know that I\u2019m not on the inside nor the CEO of either but from what I\u2019ve been told this seems a reasonable offer.\u201d<\/p>\n The sides announced an agreement<\/a> one week later that was retroactive to April 1, the day the previous contract expired.<\/p>\n Amy Frank got several texts from friends and family about the agreement. She\u2019d been so vocal about her frustrations, they wanted to make sure she\u2019d seen the news. But her relief was subdued.<\/p>\n \u201cSo you put everybody through all of this for nothing?\u201d she said the day after the deal was announced.<\/p>\n She had already sunk hours on the phone to ensure Allen\u2019s July 31 surgery to repair the plates holding his clavicle together would be covered. She was in no rush to call her doctors to reschedule the appointments she\u2019d skipped, figuring their phone lines would be busy. The experience had her wondering if the two sides were trying to get people upset as a bargaining tactic.<\/p>\n \u201cThat money that they\u2019re fighting over \u2014 is that really worth all of the stress?\u201d she said.<\/p>\n And after going through two disputes in three years, she can\u2019t help but wonder: How long until the next one?<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n