Leaders of Johns Hopkins Medicine have alerted their medical staff that contract negotiations with UnitedHealthcare have ended without a return to the health insurance giant’s network, according to a letter reviewed by The Banner.

Hopkins officials overseeing hospitals and doctors’ offices said anyone with coverage through United may have to pay higher out-of-pocket costs to continue with their doctors and hospitals, and told providers to encourage patients to consider alternative insurers that include the medical system in their networks during upcoming open enrollment, according to the letter.

The Hopkins providers have been out of UnitedHealthcare’s network for an estimated 60,000 patients, mostly in Maryland, but also in Washington, D.C., and Virginia, since Aug. 25, when the sides failed to come to terms on a new contract.

Both sides had said they continued to negotiate past the deadline. The failure to work out differences is an unusual outcome that is sure to annoy, and even frighten, people who will have to find new providers or likely face higher costs for care.

Hopkins Medicine leadership sent a letter to medical staff and other Hopkins officials Monday evening about the end to negotiations and planned to alert patients Tuesday morning.

Patients who have been approved by United for continuing coverage for a serious ongoing condition should be able to continue with that care at in-network rates for up to 90 days from approval, UnitedHealthcare officials had said previously.

It’s not clear how many people have been allowed to continue their care, which the insurer said would apply to people who were undergoing chemotherapy for cancer, for example.

Hopkins and United had both said the disagreements did not center on money but provisions that each said would harm patients.

Hopkins said United’s provisions had overly burdensome authorization requirements to provide care. United said Hopkins wanted to be able to exclude certain employer-sponsored plans. Both sides disputed the characterizations.

Joseph Ochipinti, UnitedHealthcare CEO for the Mid-Atlantic region, said in a statement that it was Hopkins that was “walking away” from negotiations and called their demands “unacceptable.”

”We expect network providers to honor their commitment to care for the individuals and families who rely on them as in-network providers,“ he said in a statement.

Ochipinti said UnitedHealthcare remains at the negotiating table.

Hopkins officials did not rule out an agreement in the future. But Kim Hoppe, a Hopkins spokeswoman, said the sides could not “find common ground” after more than eight months of negotiations, and accused United of choosing “profits over patients.”

“We decided to make patients aware of this stalemate now, to provide our patients and their employers the time they need to explore alternative insurance options during the upcoming open enrollment season,” Hoppe said Monday night.

This story has been updated to clarify that the letter from Hopkins officials encourages providers to talk to their patients about insurance alternatives.

This is a developing story.