Tens of thousands of patients at Johns Hopkins Medicine could be out of network starting Monday if the hospital system and UnitedHealthcare don’t reach an agreement.

Johns Hopkins and UHC, one of the country’s largest insurers, have been negotiating their contract over reimbursement procedures — issues like the time it takes to approve services — for more than eight months. Often, disputes like this between health care systems and insurers are settled before patients see any direct impact on their care, though sometimes at the last minute.

Still, if no deal is reached, patients might not be able to use their UHC insurance at the five Hopkins hospitals in the region and many doctors’ offices across the state, as well as in Washington and Virginia.

About 65,000 people had UHC insurance and have seen a Hopkins doctor in the past year, according to the hospital system.

“This is not about money, nor is it about small administrative issues,” Kim Hoppe, a spokesperson for the system, said in a statement. “We will not sign a contract that allows an insurance company to put profits over patients’ health and well-being.”

Doctors and insurers often use contract negotiations to work out rates insurers will pay for services and to keep costs in check. Hopkins and CareFirst, the state’s largest insurer, had a similar battle over rates in 2022.

Johns Hopkins in July accused UHC of slowing down negotiations, saying it “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.”

The system agreed to certain requests by UHC, Hoppe said, including that the rates the insurers pay for services be paid to doctors.

UHC didn’t immediately respond to a request for comment on the negotiations.

According to the UHC’s website, patients in ongoing treatment for a “serious or complex” condition — including people being treated for cancer and those who are pregnant — may be eligible for continuity of care even if the insurer doesn’t reach an agreement with Johns Hopkins.

The outstanding issues are not financial, UHC said on its website, but are related to language in the contract and “protecting access to care.”

“Johns Hopkins is demanding language in its contract that would give them the right to refuse treatment for any employer it does not want to do business with,” UHC said on its website. “In other words, they are attempting to reserve the right to turn away UnitedHealthcare members at their discretion as an in-network provider. This is unacceptable.”