It's not just patients who are sick of fighting health insurers. Doctors are frustrated, too.

MW It's not just patients who are sick of fighting health insurers. Doctors are frustrated, too.

By Erica Rowe Urquhart

I'm a surgeon with my own practice, and physicians like me struggle with millions of dollars in unpaid claims and delayed payments

Disputes between health insurers and medical providers are on the rise.

A major health insurer beats expectations by aggressively controlling medical costs, while hospitals struggle to maintain their margins.

By monetizing administrative burdens like excessive prior authorizations and a drawn-out accounts-receivable process, insurers reported record-breaking profits and made it harder for hospitals and patients to navigate care. Investors may see short-term gain, but betting on payers over those who deliver care breeds market fragility. Not even the country's best health system can survive this unsustainable model.

In September, UnitedHealthcare $(UNH)$ announced that Johns Hopkins Medicine would no longer be in network for most of its health-insurance plans. The flagship medical center, which is known for doing complex surgeries and running life-saving cancer trials, was suddenly out of network for about 60,000 enrollees in Maryland, Virginia and Washington, D.C. After eight months of contract talks, Johns Hopkins Medicine lost a chunk of its patient network.

Why did the talks fail? The Johns Hopkins executives rejected UnitedHealthcare's aggressive prior-authorization tactics, citing an intolerable burden on hospital staff and dangerous delays in sometimes life-saving treatment. They insisted the insurer's tactics directly impeded care and undermined the ability of their clinicians to help patients. Hopkins demanded a contract that stopped blocking access to care.

In response, UnitedHealthcare said it didn't want to set a precedent in which a major system could pick and choose which employer-sponsored patients it would see. That's something no other health system was allowed to do. In reality, many employer-sponsored plans utilize harsh denial practices, preventing equal access to care.

The Johns Hopkins-UnitedHealthcare dispute is a microcosm of how healthcare waste translates into profits. When clinicians seek to end management practices designed to minimize reimbursement or utilization of medical care, insurers rarely correct the underlying problem. There were about 130 publicly reported disputes between hospital systems and health plans in 2025, according to FTI Consulting, including high-profile conflicts between Stanford Health Care and Elevance Health (ELV) in California and between the Ascension hospital system and Blue Cross and Blue Shield of Texas. That's up from roughly 85 in 2023.

Here's the playbook: Insurers fixate on keeping medical costs in check, which means that hospitals and clinicians are beset by "payment delays, excessive prior authorization, and aggressive claim denials." They depend on restrictive tactics like prior authorizations and denials to squeeze the "medical cost trend" and maximize their margins. Health systems and private practices are stuck navigating labyrinthine rules, having to deal with millions of dollars in unpaid claims, hiring extra staff to fight denials, and facing compromised patient care.

The pattern is clear - insurance companies get rewarded for their ability to profit from system complexity. Every extra phone call, form, denial, or contract clause becomes a method to manage spending.

In a typical American medical practice, millions of dollars are in limbo as "accounts receivable." Those are claims that were authorized, coded and submitted on time. In our New Jersey surgical practice, health insurers often request extra documentation, initiate secondary reviews or simply ignore our communications. For providers like myself who depend on reimbursement, this is not just an annoyance. It amounts to an interest-free loan to the health-insurance company.

In some cases, we have waited months and sometimes years for payment for surgeries, even when prior authorization was secured. After involving attorneys and securing a favorable mediation verdict, we may still wait even more years to get paid for the medical care we provided, despite laws requiring payment after a decision within 30 days. These prolonged cycles have forced our practice to hire more billing staff, pay attorneys 25% of our reimbursement once they are in mediation and chase dollars we have already earned. Waiting to get paid for surgeries done years ago means we are not just frustrated - we are acting as a bank for insurers while our revenue sits on their balance sheets.

Insurers and their administrative intermediaries have turned delaying payment into a feature, not a bug. Every extra week our claims remain unpaid is another week the cash stays in their accounts, while we are the victims of "medical cost management."

Healthcare business models have become finely tuned to this asymmetry, and this has become the dividing line between insurers and providers. Those who depend on reimbursement wait, and those who control reimbursement grow even richer.

Erica Rowe Urquhart is a Hospital for Special Surgery-trained orthopedic surgeon in New Jersey. She received an executive MBA at the University of Oxford's Saïd Business School. Her first book, "The Invisible Hand Wielding the Scalpel: Paying the Price in America's Fractured Healthcare System," was released in February.

-Erica Rowe Urquhart

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April 02, 2026 11:54 ET (15:54 GMT)

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