Thousands of people with upcoming appointments at Johns Hopkins hospitals or doctors’ offices woke up to an email, robocall or other message Monday morning warning that their insurance will not cover their routine wellness checks, surgeries or most care outside of an emergency.

Hopkins, among the nation’s top health care systems, and UnitedHealthcare, a major insurer, failed to reach an agreement to keep Hopkins in-network.

It’s a dramatic, and potentially chaotic, turn for the normally technical and behind-the-scenes re-negotiation of terms that is likely to further fuel public frustration with the health care system .

The stalemate could affect more than 60,000 patients — mostly in Maryland, but also in Virginia and Washington, D.C. — who have UnitedHealthcare coverage through an employer-sponsored plan, the state health exchange, Medicare Advantage or Medicaid.

Patients could be responsible for more or all of the costs of their care at any of the five Hopkins hospitals or any doctors’ offices in the Baltimore-Washington region.

Both sides say the issue isn’t money; rather, each blames the other for making demands that they say harm patients.

Hopkins says a top issue is UnitedHealthcare’s excessive process to get authorization to treat patients, though the insurer said it approved 90% of claims shortly after they are submitted.

On UnitedHealthcare’s list is what it says is Hopkins’ insistence that it can deny doing business with certain employer-sponsored plans. Hopkins says that is a distortion, and that officials there only want all plans to adhere to the same basic standards.

“Johns Hopkins has been working with United for over eight months to update important pieces of our contract to prioritize patient protections and improve access to care,” a letter from Hopkins leadership to patients reads. “Despite our best efforts, we have been unable to get United to agree to a contract that puts patients ahead of profits.”

UnitedHealthcare leadership has a different take in its statement:

“Despite our repeated efforts to compromise and extend our contract to avoid disruption, Johns Hopkins refused. While we remain committed to continued negotiation, our top priority now is providing people with the care they need through continuity of care or a smooth transition to another provider.”

It’s unclear when, or if, the sides will come to an agreement. But both say talks continue, given the number of people potentially effected.

Normally, things don’t go this far. In 2022, for example, Hopkins and the state’s largest insurer, CareFirst BlueCross BlueShield, threatened to part ways when they couldn’t agree on reimbursements. But they settled just ahead of their deadline, and patients weren’t affected.

What should patients do?

• UnitedHealthcare officials say people covered by its plans should go to the nearest hospital in an emergency, including Hopkins, and the insurer will cover it as in-network.
• Those who are receiving active care for serious or complex conditions, such as cancer or pregnancy, can stick with Hopkins by seeking continuity of coverage. But patients must apply. The insurer says it has proactively contacted some of those patients to apply, and Hopkins officials say they can help with paperwork details.
• Call the number on the back of your insurance card for help understanding if you can continue your care, if you need help transitioning to another provider, or if you have other questions.
• If you have a billing dispute that you can’t resolve, consider mediation services from the Attorney General’s Health Education and Advocacy Unit. And if you have medical debt and need help determining if you qualify for financial assistance, you can contact Economic Action Maryland Fund.