Dear Mr. Thompson,

I am writing to you on behalf of Ensemble, a dedicated revenue cycle partner committed to the financial health of hospital systems across the nation. By way of background, our organization manages $35 billion in net patient revenue for over 250 hospitals across the United States.

We have recently been made aware of your new nationwide Hospital Inclusive Charges Policy, set to take effect in December 2024. Upon review, we anticipate that this policy, which is effectively a line item denial policy, may disallow reimbursement for an indeterminate and potentially broad range of separately billed items and services. As such, it raises more questions than answers and significant concerns for our healthcare partners and the patients they serve.

UnitedHealthcare has reported record profits in recent years, yet this new policy appears to be a strategic move to further reduce reimbursement at the expense of patient care. A line-item denial approach would not only undermine the financial stability of hospitals, but it would also contradict federal guidelines that support separate billing for many of the items and services you may soon deem “routine” and ineligible for reimbursement.

We urge you to reconsider this policy for the following reasons:

1. Impact on patient care: By denying hospital charges for separately billed items and services that UnitedHealthcare deems routine, this policy risks compromising the quality of care provided to patients. Hospitals rely on fair reimbursement to maintain high standards of care and to invest in necessary resources and personnel.
   
   
2. Financial strain on hospitals: Line item denials place additional financial strain on hospitals, particularly those with contracts paid on a percentage-of-charge basis or with stop-loss provisions. This could lead to reduced services, staff layoffs and other measures that negatively impact patient care and the larger community.
   
   
3. Contradiction of federal guidelines: Your policy appears to contradict federal authorities that support separate billing for many of the items and services you now presumably plan to deny as routine services. This policy does not appear supported by the regulatory framework, and it may undermine the contractual agreements in place.

At Ensemble, we believe that the best outcomes for payers and providers come from working together to find commonsense solutions. We are committed to holding all parties accountable and working in good faith to solve some of the toughest challenges in healthcare. We are ready to collaborate with UnitedHealthcare to develop appropriate practices that remove administrative waste and ensure fair reimbursement policies.

We call on UnitedHealthcare to engage in meaningful dialogue with healthcare providers and stakeholders to develop fair and equitable reimbursement practices. Together, we can find solutions that support both the financial health of hospitals and the delivery of high-quality, medically necessary patient care.

Thank you for your attention to this critical matter. We look forward to your response and to working together to address these challenges.

Sincerely,

Shannon White
Chief Operating Officer
Ensemble Health Partners