United HealthCare and doctors are at war. And N.J. women now face $1M in rejected claims.

When UnitedHealthcare and a large OB-GYN medical practice in New Jersey and Pennsylvania parted ways in April over reimbursement rates, the insurance giant said the dispute would not disrupt coverage for the patients who were in mid-pregnancy or getting cancer treatment.

But Axia Women’s Health officials claim UnitedHealthCare has reneged on that promise. They say there are about 400 patients who held “continuity of care” agreements with UnitedHealthcare but collectively were billed $300,000 for deliveries, ultrasounds and other treatment they expected the insurance company would cover.

All told, Axia has helped file appeals on behalf of 2,300 patients with $1 million in unpaid bills rejected for “out-of-network” care.

“In the most egregious situations, UHC’s errors are shifting $5,000 or more to individual patients’ financial responsibility for services that are covered under Continuity of Care,” Axia Women’s Health spokeswoman Chrissy Gerardi said.

A UnitedHealthcare spokesman declined to respond to specific questions about the number of appeals or the issues with continuity agreements. Patients may contact Axia Health or UnitedHealthcare if they have questions, the spokesman’s emailed statement said.

As many as 60,000 patients in New Jersey and Pennsylvania lost in-network access to their obstetricians and gynecologists on April 1 when Axia and UnitedHealthcare announced they were at a stalemate over reimbursement rates.

To cushion the blow, UnitedHealthcare informed patients who were pregnant, had “newly diagnosed or relapsed cancer, or those currently in active cancer treatment” may request to temporarily maintain their coverage, according to a message on UnitedHealthcare’s website.

Keri Urban of Hasbrouck Heights, a 20-year Axia patient with a history of miscarriages, was among those approved for continued coverage. But after undergoing a procedure in April, she received a $4,833 bill anyway, while UnitedHealthcare paid just $237.

Axia confirmed Urban’s account, noting UnitedHealthcare has denied Urban’s appeals twice.

“I did not go for my 6 month follow up because of all of this,” Urban said. “I had a quick email conversation with my doctor and decided to wait until my annual exam coming in March since UHC will still cover preventive care.”

The experience has been like “a roller coaster, up and down,” she said.

UnitedHealthcare has repeatedly blamed Axia for demanding “unsustainable price hikes despite already being significantly higher cost compared to its peers,” according to a company statement. “We’re open to negotiation should Axia provide a proposal that’s affordable for consumers and employers.”

United Healthcare claims Axia sought reimbursements that were 30% on average higher than other OB-GYNS.

Axia disputes this, saying their comparisons with competitors show then earning less. “They pay hospitals for the exact same services 20% more,” said Dr. Thomas Dardarian, Axia’s chief medical officer.

Axia compares itself with hospital providers because it has such a large network of physicians in New Jersey and the Philadelphia region. For delivering a baby vaginally, Axia has received a median reimbursement of $4,560, 19% less than what UnitedHealthcare pays doctors from large OB-GYN practices and hospital chains throughout New Jersey, Gerardi said. For c-section births, Axia’s median payment is $5,136, 32% less competitors, she said.

“Axia and our patients did everything by the book yet UnitedHealthcare has not adjudicated these claims properly,” said Rohit Singh, Axia’s chief strategy and growth officer. “UnitedHealthcare has shifted thousands of dollars in patient responsibility inappropriately.”

Singh said federal law requires insurers to honor continuity-of-care agreements for patients in the midst of treatment of a “serious and complex condition.” The law defines this as an “acute illness that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm, or a chronic condition that is life-threatening, degenerative, potentially disabling, or congenital and requires specialized medical care over a prolonged period of time.”

This includes pregnancy, according to the No Surprises Act, a federal law which took effect in January 2022.

The feud between Axia and UnitedHealthcare continues to cause frustration for patients.

One Axia patient who declined to be identified shared a complaint letter she sent to the state that questioned whether Axia was driving up costs unnecessarily.

“After I received my continuity of care approval from United Healthcare upon Axia’s termination of contract with that insurance company, the doctors began to push unnecessary testing without clinical indication and absolutely no change to mine or the baby’s health,” according to the woman’s letter. “The timing of this suggests Axia medical staff were trying to get additional payments for unnecessary tests.”

Gerardi, the Axia spokeswoman, said it was not aware of this patient’s complaint, and stressed that “all clinical recommendations are based on what we believe is best for the patient’s health.”

“We use an evidence-based approach to determine what tests or procedures are recommended to ensure the health and well-being of the mother and the baby,” she said. “None of this is determined by a payer’s insurance status.”