Johns Hopkins Medicine hospitals and doctors are now officially out-of-network for people with UnitedHealthcare insurance coverage. The change is likely jarring for many of the 60,000 people, most of them in Maryland, who have a Hopkins provider.

Here’s what you need to know about the upheaval and what to do if you’re affected.

What happened?

Baltimore-based Johns Hopkins and UnitedHealthcare negotiated a new contract for eight months, with each side accusing the other of policies that hurt patients, but denying the other side’s claims.

For Hopkins, one of the region’s largest medical providers, officials said the primary issue was the insurer’s insistence on an overly burdensome authorization process for care. At United, one of the largest U.S. insurers, officials decried Hopkins’ effort to exclude some employer plans.

Their previous agreement expired Aug. 25. The negotiations continued however, until Monday when Hopkins said talks had ended. Hopkins said no new talks are planned, and it’s not clear if there will be a resolution in the future.

The breakup means patients with United insurance in Maryland, Virginia and Washington, D.C., through employer-sponsored plans, the state health exchange, Medicare Advantage or Medicaid will all be out-of-network and subject to higher costs if they continue with Hopkins providers.

There are exceptions. Officials say patients should confirm with Hopkins and United that they could remain in-network under these plans:

• Medicaid coverage for mental health and addiction services provided through the Optum Behavioral Network.
• Medicare supplemental plans, as long as Hopkins medical providers have already accepted the patient’s original Medicare coverage and are still willing to see them.
• UnitedHealthcare Group Retiree PPO plans, as long as Hopkins providers are Medicare-approved and accept the plan. They will be considered out of network, but the cost should be similar to in-network rates. Look for more information here.

What is out-of-network?

With United customers no longer considered in-network at Johns Hopkins, those patients will no longer be billed at negotiated in-network rates at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore; Johns Hopkins Howard County Medical Center; Suburban Hospital in Bethesda; and Sibley Memorial Hospital in Washington, D.C. (Johns Hopkins All Children’s Hospital in Florida is the exception.). Visits at Hopkins’ outpatient centers and doctor offices also are out-of-network.

Patients who continue seeing these providers will likely pay more or all of their bill, depending on their plan. An important exception is for emergency hospital visits at Hopkins, which will continue to be billed at in-network rates.

How can you keep seeing your doctors?

Some patients are entitled under federal and state law to “continuity of care,” according to the Maryland Insurance Administration.

That means they will be billed at in-network rates for up to 90 days while they continue to see their Hopkins providers for serious or complex conditions. Some of those are patients who would be receiving cancer treatments, undergoing institutional or inpatient care, waiting for scheduled, nonelective surgeries. They also include those who are terminally ill or pregnant.

Patients also qualify for the continuity of care if there are no other in-network providers offering care for their specific condition, according to the Maryland Insurance Administration.

UnitedHealthcare said people must to apply to receive the continuity-of-care status. Chance of success appear strong: Officials say they’ve already approved 99% of applications.

The 90-day extension begins when patients go out-of-network and can be extended depending on the treatment course. Hopkins providers are helping patients fill out the necessary paperwork, said Kim Hoppe, a Hopkins spokeswoman.

How do people find new providers?

UnitedHealthcare says its network remains broad for those who use its insurance; it includes more than 120 hospitals, 12,000 primary care physicians and 27,000 specialists.

Those needing help selecting a new hospital or provider should call the number on their health plan card or go here.

Traci Kodeck, CEO of HealthCare Access Maryland, which helps people navigate health insurance, said many people will need help identifying primary care doctors and specialists who can meet their needs. She said they’ll also need assistance to find those who are located near them, willing to new patients and see them in a timely way.

Kodeck recommended that any patients who qualify for continuing care should apply so they can continue seeing their same providers into next year.

“My concern is that people are going to have delays in getting care and preventive services,” she said. “Sometimes you find a new doctor who meets your needs, but new-patient appointments are six months down the line. These are things to ask about.”

Some may have the option to change plans during their fall open enrollment for coverage beginning Jan. 1.

Hopkins’ Hoppe said officials notified patients and employers of the stalemate early along so they would have time to find alternative insurance options that include Hopkins.

Other assistance is available:

• Those with Medicaid plans should call a state helpline at 800-284-4510 or go here.
• HeathCare Access Maryland has navigators to help with office hours for open enrollment for the health exchange this fall.
• Those who bought plans on the state’s health exchange can find other assistance here.
• Any general questions or concerns about health insurance can be directed to the Maryland Insurance Administration at 410-468-2244.