EvergreenHealth & United Contract Negotiations
Patient FAQ
General EvergreenHealth and United Healthcare Questions
What does the contract between EvergreenHealth and United Healthcare (United) cover? What are you negotiating?
EvergreenHealth and United are currently negotiating a contract that outlines the EvergreenHealth and EvergreenHealth Monroe services United insurance plans cover and the corresponding reimbursement rates that United pays to EvergreenHealth for providing patient care.
For several months, we have repeatedly requested that United Healthcare work with us in good faith to negotiate a new contract. As of February 2, 2026, they have not shown any urgency in working towards replacing the existing contract.
If no contract is reached by February 28, these facilities will no longer be part of United's network:
- EvergreenHealth Medical Center, EvergreenHealth Monroe and EvergreenHealth Primary Care locations
- EvergreenHealth Urgent Care locations
- EvergreenHealth Home Health & Hospice Care, EvergreenHealth Emergency Departments, Specialty and Ambulatory Care practices
Due to recent changes in state law, EvergreenHealth was not allowed to notify you during the open enrollment period for most insurance plans during the fall of 2025. The new state regulations prevent care providers and insurance companies from announcing a potential contract termination until 45 days before the termination date.
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Why are EvergreenHealth and United negotiating their contract?
EvergreenHealth has recognized the need to negotiate changes in our contract because the current cost of patient care isn't aligned with the reimbursement EvergreenHealth receives from United. Our current contract with United expires on March 1, 2026. However, we are working with United to come to an agreement for a new contract before then.
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United Contract Questions
What are reimbursement rates?
The reimbursement rate is the amount of money an insurance company like United pays (or reimburses) a hospital like EvergreenHealth for the care and specific services that hospital and its staff provide a patient who has coverage through that particular insurance company.
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What do reimbursement rates have to do with my care?
If you have insurance and visit a hospital or doctor's office to receive care, the cost of your care is covered upfront by the hospital or physician's practice. The hospital or practice then submits a bill for the services you were provided to your insurance company. The insurance company then reimburses, or pays back, the hospital/doctor's office for the services and care you received.
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Are reimbursement rates based on the cost of care? How are reimbursement rates established?
How much your insurance company reimburses the hospital for services is based on each patient's insurance plan coverage as well as the reimbursement rates established in the contract between the hospital or practice and the insurance company. These reimbursement rates do not change immediately with the changing cost of care but are negotiated on an annual basis.
Insurance companies are allowed to negotiate different reimbursement rates with each hospital.
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Why are reimbursement rates lower than the cost of care?
Reimbursement rates are, in some cases, lower than the cost of care. United's reimbursement rates with EvergreenHealth are currently so low because the cost of care has been driven significantly higher over recent years by factors beyond our control, and United's rates do not coincide with rising costs for staff, pharmaceuticals, and supplies.
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What can happen if reimbursement rates remain low? What can happen if this kind of situation were to continue?
If a hospital like EvergreenHealth or EvergreenHealth Monroe is unable to successfully cover the cost of care, the hospital or affiliated outpatient practice is forced to make structural changes that could include pausing important services for our patients, among other things. Like any organization, even not-for-profit hospitals like EvergreenHealth must take in enough revenue to cover expenses.
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Will the contract be resolved? When will it be resolved?
EvergreenHealth is working in good faith with United to negotiate a new contract so that we can reach an agreement and avoid any disruptions to patients as quickly as possible. We hope that a new agreement will be reached by February 28, 2026.
If an agreement is not made before March 1, EvergreenHealth will no longer be contracted as an "in-network" United provider, and patient responsibility, or out-of-pocket costs, may increase for United patients. We encourage you to contact United to learn how your coverage will be impacted at EvergreenHealth if the contract terminates and to urge them to come to the table so that EvergreenHealth providers and hospitals may remain in your network.
Regardless, please know that you and all patients are always welcome to seek care at EvergreenHealth, no matter what insurance or coverage you have.
EvergreenHealth will continue to strongly advocate for our United patients to retain access to their trusted doctors and care team here, within their community. We know that access to healthcare is already challenging in our region, and that our patients do not want to endure long wait times to see a provider at another system or unnecessary travel to Seattle or other inconvenient locations for in-network care.
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Medicare & Medicaid Questions
For Patients With Medicare Advantage
As a patient receiving Medicare Advantage benefits through United, Medicare offers you an additional open enrollment period from January through March each year to complete a one-time switch either to a different Medicare Advantage plan or to traditional Medicare. You may still participate in the Annual Open Enrollment in Fall 2026.
For more help finding another Medicare Advantage plan that works for you, we encourage you to contact American Senior Resources at 1 (877) 915-7528 Monday through Friday from 8 a.m.-5 p.m.
Additionally, American Senior Resources hosts monthly Medicare 101 Workshops at EvergreenHealth's Kirkland campus in the Red Auditorium across from the Emergency Department. The next workshop takes place on Feb. 11 at 10 a.m.
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For Patients Receiving Medicaid through United
As a patient receiving Medicaid coverage through United, you have the option of switching plans at the beginning of each month. If you utilize EvergreenHealth Primary Care Services and Specialty Care, you may switch to Coordinated Care or Washington State Apple Health to remain in network. If you only utilize EvergreenHealth Specialty Care you may switch to Community Health Plan of Washington or Molina Healthcare to remain in network.
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Continuity of Care Questions
I am planning to deliver my baby/am receiving cancer treatment/ or have an established long-term treatment plan at EvergreenHealth for a critical or chronic illness. Will my coverage still end if the contract is terminated? How am I impacted?
For patients currently undergoing life-saving treatment; those with active, long-term care plans; or those scheduled for a non-elective surgery, the "No Surprises Act" requires that United extend the duration of insurance coverage up to 90 days after he contract termination date for patients who qualify as Continuing Care Patients – such as those patients in cancer treatment or expecting to deliver a baby at EvergreenHealth.
It's important to know that patients who qualify for extended coverage under the "No Surprises Act" will not automatically receive extended benefits. United requires that patients who qualify for Continuing Care coverage call the customer service phone number on the back of their insurance ID card to request "Continuity of Care".
For more information about the No Surprises Act and Continuing Care Patients qualifications, please visit the Centers for Medicare and Medicaid Services website at www.cms.gov or reach out to United by calling the number on the back of your membership card.
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Our Commitment to You and Everyone We Serve
As a public hospital district, it is an inherent part of our mission to provide access to high-quality, high value care for everyone we serve in our district. At EvergreenHealth, that means hiring top clinical experts and providing the best possible outcomes at an affordable cost – which is illustrated by our recognition from Healthgrades as a Top 50 hospital in clinical excellence, and our rank as second in the state by the Lown Institute for providing our community with a high value of care. Our sole priority is doing everything we can to support and improve the health and wellness of everyone in our community.
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