After eight months of tense negotiations, the contract dispute between Johns Hopkins and UnitedHealthcare has left thousands of patients in limbo, a situation that highlights a growing trend in the American health care landscape. According to reports from NPR and other outlets, these standoffs between hospitals and insurers are becoming increasingly common, and patients are often the ones who suffer most.
The impasse between Johns Hopkins and UnitedHealthcare, unresolved as of August 25, 2025, is just the latest in a string of similar conflicts nationwide. Earlier this year, the University of Missouri and its MU Health Care system let their contract with Anthem, a major insurer, expire in April. This left 90,000 central Missouri patients suddenly out-of-network—and scrambling to figure out if, or how, they could continue care with their trusted providers.
For Amy Frank and her husband Allen, this meant nearly three weeks and 17 hours on the phone, bouncing between their insurer and the hospital system, trying to ensure that Allen’s post-surgery care would be covered. “It was just a big loophole we were caught in, going around and around,” Amy Frank told NPR. The hospital told her to call the insurer; the insurer told her to have the hospital fax a form to a special number; the hospital said they’d been instructed to send faxes to a different number. The result? Endless frustration and uncertainty, with the Franks and thousands of others trapped in a bureaucratic maze.
These disputes are not isolated. In New York City, negotiations between UnitedHealthcare and Memorial Sloan Kettering Cancer Center missed a June 30 deadline, briefly leaving cancer patients in limbo until a deal was struck the following day. In North Carolina, Duke Health recently announced it could leave the Aetna network unless the insurer agreed to pay higher rates. The Frank family, for their part, had already switched some of their providers once before due to a 2023 contract dispute between Anthem and a primary care group in Jefferson City, Missouri.
“A growing number of Americans find themselves in a similar pinch,” NPR reported. Data backs up this trend: from June 2021 to May 2025, 18% of non-federal hospitals experienced at least one public contract dispute with an insurance company, according to preliminary findings from Jason Buxbaum, a health policy researcher at Brown University’s School of Health. Over the same period, 8% of hospitals went out-of-network with an insurer, at least temporarily.
Why are these disputes on the rise? Experts point to hospital consolidation and rising health care costs as major drivers. Hospital expenses grew 5.1% in 2024, outpacing the 2.9% inflation rate, according to the American Hospital Association. Labor costs are a huge factor, with advertised nursing salaries rising 26.6% faster than inflation from 2020 to 2024. Hospitals, facing these ballooning costs, are pushing insurers for higher reimbursement rates.
Hospital consolidation is part of the story, too. Over 2,000 hospital mergers have been announced since 1998, including 428 from 2018 to 2023, NPR noted. While some mergers can bring efficiencies, they also reduce market competition and give hospitals greater leverage in negotiations. “Insurer markets have been consolidated for a long time,” Buxbaum explained. “What’s changed is how consolidated the hospital markets have become.” Now, when a hospital system drops out of a network, it’s not just one facility—it’s often all or most of the key providers in a region, making the threat of going out-of-network a powerful bargaining chip.
For patients, the consequences are immediate and stressful. During the three-month standoff in Missouri, most patients couldn’t switch insurance midyear. They faced a tough choice: pay higher out-of-network prices, delay care, find new providers, or navigate a paperwork gauntlet in hopes their situation qualified for a 90-day extension of in-network rates. The timing couldn’t have been worse for Allen Frank, who was recovering from a serious injury and needed follow-up surgeries. Amy Frank described the experience as “very frustrating,” adding, “I’ve got my own medical issues, and I don’t feel like mine are bad enough to be fighting for a continuity of care.”
Some legal protections exist. The federal No Surprises Act, in effect since 2022, allows patients with serious conditions to keep in-network rates for up to 90 days with their current providers, giving them a temporary reprieve. But as Amy Frank’s ordeal shows, actually securing these protections can require persistent advocacy and hours of phone calls. Eventually, Anthem agreed to let Allen continue his care at MU Health Care, but even then, communication breakdowns nearly derailed appointments. “He refused to leave without being seen,” Amy recalled, and only after a nurse managed to reach Anthem was Allen’s care approved on the spot.
Insurers and hospitals alike say they’re acting in the best interests of patients, but the financial pressures are real. As negotiations between MU Health Care and Anthem broke down, the insurer claimed the hospital was seeking a 39% rate increase over three years, while the hospital said the insurer wouldn’t budge past a 1%-2% increase. The Missouri Senate Insurance and Banking Committee intervened with a hearing on June 30, 2025, breaking months of deadlock and prompting Anthem to double its rate increase offer by July 8. A deal was reached one week later, retroactive to April 1, 2025.
The relief among patients was palpable but muted. “So you put everybody through all of this for nothing?” Amy Frank asked, reflecting on the hours spent ensuring her husband’s surgery would be covered. “That money that they’re fighting over — is that really worth all of the stress?”
Industry observers say the trend may worsen. Trump administration policies, including a massive tax-and-spending law that slashes federal health care spending by about $1 trillion over the next decade, are putting additional pressure on hospitals. The legislation includes a $911 billion drop in Medicaid spending and is expected to cause 10 million Americans to lose their insurance. “They’re going to be more hard-nosed at negotiating with the health plans because they’re going to be in a survival mode,” said John Baackes, a retired insurance executive and former board member of AHIP, the national trade group for health insurers.
Both sides, meanwhile, insist they’re focused on fairness and patient care. “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted,” said Buddy Castellano, spokesperson for Anthem’s parent company, Elevance Health. “Our commitment remains clear: ensuring access to care while keeping coverage affordable for the families, employers, and communities we serve.” MU Health Care spokesperson Eric Maze echoed the sentiment: “We understand and are sorry for the stress and concern being out of network created for many, and we are deeply grateful for the patience and trust placed in us during this time.”
For now, though, patients remain caught in the crossfire, hoping that the next round of negotiations won’t once again leave them fighting for the care they need.
