Tens of thousands of patients at Johns Hopkins Medicine and UnitedHealthcare just received news some may find startling.

The patients may not be able to use their insurance at their next appointment in a Hopkins hospital or doctor’s office.

That’s because Baltimore-based Johns Hopkins, one of the preeminent hospital systems in the country, and UHC, one of the largest insurers, are locked in negotiations over reimbursement procedures, including such things as approvals for services, the time it takes to approve services, and some weedier issues surrounding who can even be seen.

However dire the messaging about UHC dropping Hopkins from its network, both sides say they want to continue the relationship so patients can keep seeing their doctors.

The deadline for an agreement is Aug. 25. If no deal is reached, doctors in five Hopkins hospitals in the region and all the doctor’s offices used by patients largely in Maryland will be out of UHC’s network.

UHC says this affects those in plans bought through employers, Medicare Advantage and Medicaid, and those purchased individually.

Hopkins said in a statement that negotiations have been going on for seven months.

“Unfortunately, UnitedHealthcare has chosen to slow down negotiations recently because we refused to accept their harmful practices that hurt patients: aggressive claim denials that delay necessary care, excessive red tape that forces patients to wait for treatments, and significant payment delays that strain our ability to provide care.”

Negotiations are common for doctors and insurers, where each side usually works out rates the insurers will pay for services, the process for approvals and some guardrails to keep costs in check.

In this case, Hopkins and UHC have agreed to the rates to be paid to doctors, which is often the most contentious item on the list.

It was the battle over rates in 2022 that caused a similar fight between Hopkins and CareFirst, the state’s largest insurer, but the sides worked out their differences before the deadline.

These agreements affect only doctors. In Maryland, rates paid to hospitals by insurers both private and public are set by the state. Doctors don’t fall under that system, which is a reason that patients can get more than one bill for their share of the costs.

UHC sent letters a week ago to just under 60,000 Hopkins patients informing them about the negotiations. Days later, Hopkins sent letters to about 65,000 patients with UHC insurance who have appointments in the next couple of months or who have seen a Hopkins doctor in the past year. The majority are in Maryland, though some are in Virginia and Washington, D.C.

Hopkins’s hospital in Florida is not affected.

Joseph Ochipinti, UHC’s CEO for the Mid-Atlantic region, said in a statement that the company will remain at the negotiating table.

“Our negotiation isn’t about money. We’ve reached agreement on financial terms. However, Johns Hopkins is requiring contractual provisions that would negatively impact our members and employers, allowing them to turn patients away at their discretion.”

Patients do not need to do anything at the moment. Hopkins and UHC said they would continue notifications about the negotiations.

If Hopkins is dropped from the network, UHC said that patients can continue with a Hopkins provider while they are receiving care for a serious or complex issue. That would include cancer treatment or pregnancy care, though they would have to request a continuity of care exception.