Elisa Graves at her home in Jericho on Friday, March 4. Graves is about to start chemotherapy at UVM Medical Center for a rare and serious type of cancer, but is worried about starting treatment because she said UnitedHealthcare told her it would only cover about 30 days of chemotherapy. Photo by Glenn Russell/VTDigger

About 2,900 patients covered by UnitedHealthcare may not be able to see providers at the University of Vermont Medical Center and connected hospitals, as the nation’s largest insurance company and Vermont’s largest health network have been unable to secure a contract.

If the stalemate persists, hundreds of patients will be sent rushing to find providers in an area with increasingly few options — and in some cases, no close substitutes for the specialists they need.

Among them is Elisa Graves, 34, of Jericho, who is about to start chemotherapy at UVM Medical Center to treat a rare and severe form of cancer. Now, she said, she’s worried about starting treatment because she said UnitedHealthcare told her it would only cover about 30 days of chemotherapy.

“It’s life or death for me,” Graves said. “It’s criminal. It feels like a hostage situation, and they definitely don’t care at all about the people they influence.”

A February 23 letter distributed by UnitedHealthcare to its customers warned them that coverage at the University of Vermont Health Network may end for patients on employer plans and individuals beginning April 1.

“We are working hard to expand their participation to keep them in the network for employers and individual healthcare plans,” the letter read.

UnitedHealthcare said Medicare Advantage, Medicare Supplemental Insurance and Vermont’s Veterans Affairs will not be affected.

UVM said it will continue to accept UnitedHealthcare insurance for home health care patients and elderly patients.

A February 23 letter tells clients that if UnitedHealthcare cannot reach an agreement with the University of Vermont Health Network, patients will lose their coverage at the University of Vermont Medical Center, Central Vermont Medical Center in Berlin, Porter Medical Center in Middlebury, and three hospitals in New York: Alice Hyde Medical Center, Champlain Valley Physicians Medical Center and Elizabethtown Community Hospital.

And if patients seek care outside of the UnitedHealthcare network, he warns that their costs will rise or they may have to pay the full cost of medical care.

The letter recommends clients transfer their care to Copley Hospital in Morrisville, Gifford Medical Center in Randolph or Northwestern Medical Center in St. Albans, or one of two New York hospitals: Adirondack Medical Center or Potsdam Cantonal Hospital.

The letter assures clients that they can still get emergency care at any hospital.

The insurance company tells customers that they may be able to continue care at the University of Vermont Medical Center and its affiliated hospitals for a short time if they are pregnant, receiving active treatment for a disease, or are receiving treatment such as chemotherapy.

Most of the 2,900 patients that UnitedHealthcare estimates will be affected live in Vermont, some in New York. Could not provide exact numbers.

UnitedHealthcare cited the higher costs in UVM – which it attributes to UVM’s market dominance – for its decision to allow its contract with UVM to expire. UnitedHealthcare said UVM is seeking a roughly 10% increase in its rate for fiscal year 2022. The insurer said the cost of UVM care for its members on employer plans and individuals has increased 15% since 2020.

“The rapid acceleration of costs in the University of Vermont Health Network is not affordable or sustainable for residents and employers of Vermont and Northern New York,” United Healthcare said in a statement.

“Our top priority is to renew our relationship with the health system so that our members have continuous access to quality, affordable care. We hope the University of Vermont (Health Network) will share the same commitment and will work with us to ensure that the people and employers we mutually serve continue to have uninterrupted access to health care.”

UVM Health Network officials – who said their decision not to renew the contract – blame the rising costs on increased staffing, supply and drug costs.

“Our network remains one of the least expensive in the country, but we have to cover our costs to provide timely access to quality care,” the health network said in a statement.

The health network also criticized the administrative obstacles at UnitedHealthcare.

“For a number of years, our ability to provide adequate and timely care to patients covered by UnitedHealthcare Commercial Insurance, a for-profit national insurer, has been hampered by their administrative and operational requirements,” the officials said in the statement.

According to the statement, “Despite our efforts to resolve these issues, patients continue to experience unnecessary delays and restrictions on approvals for common tests, imaging, treatment, and medications, among other challenges, due to United’s reimbursement policies and practices.”

For example, UVM said a policy that began last fall prevented the medical center and its subsidiaries from scheduling colonoscopy for UnitedHealthcare patients.

UnitedHealthcare is a subsidiary of UnitedHealth Group Inc. based in Minnesota, an integrated healthcare company that also includes Optum Health, a large national network of health providers; OptumRx, Senior Pharmacy Benefits Manager; and OptumInsight, a healthcare technology company. UnitedHealth Group revenue for 2021 was $288 billion.

Elisa Graves at her home in Jericho on Friday, March 4. Photo by Glenn Russell/VTDigger

“I’m so broken”

Jericho resident Graves was recently diagnosed with pancreatic hemangiosarcoma, one of the rarest of all cancers. She said five tumors surround her pancreas.

“I just started my treatment for her with the hope that I could do anything to prolong my life,” Graves said. “It’s a very aggressive cancer, it’s just a terrible cancer.”

Most of Graves’ doctors are at UVM Medical Center.

“I’m totally devastated,” Graves said. “This affects me greatly.”

She moved back to Vermont two years ago to be near her mother, who showed early Alzheimer’s disease, and it took a long time, she said, for her to see all the doctors she needed to see her on her complex medical condition, even before he was diagnosed with cancer. She has asthma and Ehlers-Danlos Syndrome, a genetic disorder that affects the connective tissues causing her joints to dislocate easily.

With Covid, there are a lot of delays. “It’s very difficult to get anywhere with a doctor,” Graves said. “The only doctors available are at UVM, and they all have huge waiting lists.”

She injured her ankle again in July and had to wait until January to schedule an operation that led to the discovery that she had cancer. She said that because of her asthma and Ehlers-Danlos, her pulmonologist and allergist recommended a CT scan of her lungs before surgery to make sure she wouldn’t have any problems with anesthesia. That’s when the mass in her pancreas was discovered.

She said that after several delays, she was officially diagnosed on February 17. Her cancer is so rare that UVM referred her to the Dana-Farber Cancer Institute in Boston, where doctors direct her care and United Healthcare coverage. Her oncology team recommended that Dana Farber undergo chemotherapy as close to home as possible, at UVM.

“Dana Farber has been excellent, and they are amazed that this is happening,” Greaves said.

Her first oncology appointment is supposed to be at UVM Medical Center on Tuesday, but to remain covered by UnitedHealthcare, she now has to go to Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, 95 miles away.

“I don’t want to drive an hour and a half each way with a broken ankle while I’m on chemo like a dog,” Graves said. “I just don’t understand how it can be allowed and how everyone is OK with it and how UVM can see itself as pillars of society and not care about the stubbornness that many of us have no other options. It’s not like there are other hospitals nearby that equal UVM, not at all” .

She cannot switch insurance plans because her husband’s business only offers UnitedHealthcare and Kaiser Permanente, which do not cover providers in Vermont.

“I’m terrified,” Graves said. “I am so desperate to start treatment.”

She said she doesn’t know if she should keep her Tuesday appointment at UVM because she can’t go somewhere out of network for chemotherapy.

“I can’t waste time trying to transition in the midst of that and missing out on biochemotherapy when this increases exponentially every week,” Greaves said. “I’m about to dry up, and I can’t believe it.”

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