By JASON HINES
On August 1, 2025, Capital Women’s Care (CWC), a leading OB/GYN practice in the Mid-Atlantic area, terminated its network agreement with UnitedHealthcare. This pivotal decision affects numerous women throughout Maryland, Virginia, Pennsylvania, and Washington D.C. The ongoing negotiations between CWC and UnitedHealthcare exemplify how price openness can illuminate the intricacies of such critical discussions.
The Public Dispute Emerges
CWC,which employs over 250 healthcare professionals,declared that it would not renew its contract with UnitedHealthcare despite ongoing talks. The practice urged patients to contact UHC to voice their concerns about potentially losing access to their healthcare providers.
In retaliation, UnitedHealthcare released statements on its website asserting that CWC “refused to compromise on demands for considerable price hikes” and claimed that CWC’s costs are “substantially higher than those of similar providers in Maryland and Virginia.” UHC provided specific data indicating that a vaginal delivery at CWC would cost “over $2,600 more—more than an astonishingly high rate of over 120% above the average charged by other OB/GYN practices.”
This situation prompts an essential inquiry: what does actual price transparency data reveal about these conflicting claims?
Understanding Price Transparency Data
By analyzing negotiated rates from publicly available machine-readable files from UnitedHealthcare itself, we investigated common OB/GYN procedures based on Maryland’s rate data. Even though this analysis is limited to a select few procedures within Maryland rates, it provides valuable insights into the financial interactions between these two organizations. The results tell a more complex story than either party’s public statements imply.
Data Methodology Note: Our research focused on negotiated rates for Capital Women’s Care sourced from publicly accessible machine-readable files while concentrating specifically on Maryland providers and excluding outliers (rates below or above Medicare by more than five times). We assessed rates for both UnitedHealthcare and CareFirst across three commonly performed OB/GYN procedures where adequate data was available.
CWC’s Competitive Standing Against Other Insurers
The analysis of three prevalent OB/GYN procedures in Maryland reveals that CWC’s rates with UnitedHealthcare were actually quite competitive when compared to other major insurers:
- CPT Code: 56515 (Vulvar lesion Destruction): UHC paid $401 compared to CareFirst’s $617 (53.9% difference)
- CPT Code: 57288 (Sling Operation): UHC paid $1,163 versus CareFirst’s $1,254 (7.8% difference)
- CPT code: 58558 (Hysteroscopy): UHC paid $2,294 against CareFirst’s $2,318 (1.0% difference)
This sample suggests that UnitedHealthcare was already receiving favorable pricing from CWC compared to other major payers—raising questions about UHC’s claim regarding CWC being “significantly higher cost.”
A Reality Check Against Medicare Rates
The findings indicate both insurers were paying significantly above Medicare reimbursement levels based on our sample:
- UnitedHealthcare: Between143-175% over Medicare fees
- CareFirst: Between166-220% over Medicare fees
This suggests while CareFirst offered higher payments overall; even at lower percentages relative to Medicare reimbursement levels; it seems reasonable for Capital Women’s Care requesting increases may have been aimed at aligning with market standards accepted by other payers.
A Notable Limitation:This analysis is confined only to three specific procedures within Maryland datasets; thus comprehensive validation would necessitate examining all procedure codes across all markets where Capital Women operates.
The Strategic landscape: Importance of Market Share
An understanding as why Capital Women might have opted out requires looking into United Healthcare’s standing within the state market landscape. According to recent KFF statistics , United Healthcare holds merely9%,of large group market share in Maryland as per recent reports . This relatively minor position grants critically important leverage back towards C WC .
< figcaption >< em >United Healthcare ‘ s limited presence gives them less negotiating power against larger provider groups like C WC .< / em >
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The Calculations Behind Walking Away:
- U HC represents only small fraction among patients served by CW C
- CW has contracts established already with larger payers such as Aetna ,Care first & ;Cigna who offer better compensation terms .
- The practice encompasses over two hundred fifty medical professionals spanning multiple states .
- Opting out affects just nine percent share but establishes precedent setting negotiation strategies moving forward .
an Examination of Claims made By united health care :
U HC ‘ s website contains several assertions which can be scrutinized using transparency data :
Claim One : “ CW is considerably pricier when stacked up against peer practitioners ”
E valuation : Somewhat Misleading
While CW may charge higher fees than certain competitors , our inquiry reveals thay received competitive reimbursements thru various major insurance companies offering similar services .
The comparison lacks context surrounding geographical variations along quality differences among providers .Claim Two :“ Double-digit hikes leading them thirty percent beyond average ”
E valuation : Lacking Context
This statement fails consider :- < li >How current reimbursements compare amongst different insurers involved.