MOBILE — Commercial health insurance contracts between UnitedHealthcare and two of the region’s largest hospitals are set to expire at the end of September, a deadline that could change what thousands of insured patients in Mobile County pay for hospital care beginning Oct. 1.
USA Health said the commercial contracts covering USA Health University Hospital and USA Health Children’s & Women’s Hospital will expire if the two sides cannot reach an agreement by Sept. 30. If that happens, commercial UnitedHealthcare members would no longer have in-network coverage at any USA Health hospital, which the health system said could result in higher out-of-pocket costs for patients.
A third hospital in the system, USA Health Providence Hospital, has already been outside the UnitedHealthcare commercial network since Nov. 15, 2025.
Not every patient with a UnitedHealthcare card is affected. The health system said UnitedHealthcare Medicare Advantage plans and Veterans Community Care Network plans will remain in network at University Hospital and Children’s & Women’s Hospital, and that UnitedHealthcare Veterans Community Care remains in network at Providence Hospital. USA Health also said its employed physicians will remain in network with UnitedHealthcare insurance products, even if the hospital contracts lapse.
What “Out of Network” Actually Changes
A hospital contract with an insurer is, at bottom, a negotiated price list. The hospital agrees to accept set rates for services, and in exchange the insurer places the hospital in its network and steers members there with lower cost sharing. The patient sees the result as a deductible, a copay or a coinsurance percentage that is smaller when they use an in-network facility.
When a contract expires, that price list goes away. The hospital is still open and still able to treat the patient, but the visit is processed under the plan’s out-of-network benefits. In practical terms, that usually means one or more of the following: a separate and higher out-of-network deductible that has to be met from zero, a higher coinsurance share, an out-of-pocket maximum that is higher than the in-network maximum, or — in plan designs that have no out-of-network benefit at all, which is common in HMO and some narrow-network products — no coverage for non-emergency care outside the network.
There is also the question of the gap between what a hospital charges and what an out-of-network plan is willing to pay. Where a service is not protected by federal or state billing rules, that difference can be billed to the patient. That is the mechanism behind the phrase “balance billing,” and it is the reason network status matters even to patients whose plans do pay something toward out-of-network care.
None of that is automatic in this case, because the outcome depends on the specific plan document a patient or their employer holds. Cost sharing, out-of-network benefits and any transition provisions vary considerably from one UnitedHealthcare product to another.
Which Patients Are and Are Not Affected
The expiring agreements are commercial contracts — the kind that cover employer-sponsored plans and individually purchased coverage. Those are the members USA Health has flagged.
USA Health said UnitedHealthcare Medicare Advantage members would keep in-network access at University Hospital and Children’s & Women’s Hospital, and that the Veterans Community Care Network product administered by UnitedHealthcare would remain in network at those two hospitals as well as at Providence Hospital. The Veterans Community Care Network is the arrangement through which the U.S. Department of Veterans Affairs pays community providers to treat eligible veterans outside VA facilities.
Patients covered by traditional Medicare, by Medicaid or by an insurer other than UnitedHealthcare are not part of this dispute.
The distinction that matters most for a given household is often not obvious from the insurance card alone. Many large employers self-fund their health benefits and hire UnitedHealthcare only to administer the plan and rent its network; those plans carry the same logo but are governed by the employer’s plan document. Employees in that situation should be asking their employer’s benefits office as well as the insurer.
Emergency Care Is Treated Differently
USA Health noted that UnitedHealthcare is required by federal law to cover emergency services, including visits to the emergency departments at all USA Health facilities.
That protection is longstanding and has been strengthened in recent years. Federal law generally requires group health plans and issuers that cover emergency services to do so without prior authorization and without regard to whether the facility is in network, and to apply in-network cost-sharing levels to emergency care delivered at an out-of-network emergency department. Federal surprise-billing protections also restrict providers from billing patients the balance above that in-network cost sharing for most emergency services.
Separately, the federal Emergency Medical Treatment and Labor Act requires hospitals with emergency departments that participate in Medicare to screen anyone who comes in seeking emergency care and to stabilize an emergency medical condition, regardless of insurance status or ability to pay.
Those rules govern the emergency visit itself. They do not necessarily govern what happens after a patient is stabilized and admitted, or care that is scheduled in advance. A person weighing an emergency should not be doing insurance math at all — the protections exist precisely so that they do not have to.
Continuity of Care and Transition Protections
Contract expirations most sharply affect patients in the middle of something: a pregnancy, a course of chemotherapy, a post-surgical recovery, a series of infusions, an active treatment plan with a specialist at a particular hospital.
For those situations, health plans commonly offer what is variously called continuity of care or transition of care. The general idea is that when a provider leaves a network for reasons other than misconduct, a member who is actively undergoing a course of treatment may apply to keep receiving that care at in-network cost sharing for a limited period while the transition is arranged. Federal continuity-of-care requirements adopted alongside the surprise-billing rules apply to certain “continuing care patients” when a provider’s network status ends, and many plans have their own transition-of-care policies on top of that.
These protections are not automatic and they are not unlimited. They typically require the member to request them, often on a specific form, within a defined window, and they generally cover a defined course of treatment rather than open-ended care. Eligibility, duration and the conditions that qualify differ by plan.
The practical implication is that a patient who is mid-treatment at University Hospital or Children’s & Women’s Hospital should not wait to see how the negotiation ends. Asking the insurer now what transition-of-care rights the specific plan provides, and how and when to apply for them, preserves options that can be harder to exercise retroactively.
Why These Standoffs Happen
Contract expirations between hospitals and insurers have become a routine feature of the health care calendar, and they usually follow a recognizable pattern. Contracts run for a defined term. As renewal approaches, the hospital seeks higher reimbursement, citing labor costs, supply costs and the volume of care it delivers to patients whose coverage pays below cost. The insurer resists, citing premium affordability for the employers and members who fund the plan. Both sides notify patients as the deadline nears, in part because public attention is itself leverage.
Most such disputes settle, sometimes on the deadline itself and sometimes retroactively after a short gap. Some do not, as the Providence Hospital situation shows: that hospital has been out of the commercial network since November 2025.
The stakes are unusually concrete in Mobile. USA Health is the clinical arm of the University of South Alabama and operates the region’s academic medical center. University Hospital houses services that are not duplicated at every community hospital, and Children’s & Women’s Hospital is the region’s dedicated pediatric and obstetric facility. For families with a child in specialty care or a pregnancy well along, “go somewhere else” is not a neutral instruction.
What Patients Should Do Before Oct. 1
USA Health said patients with questions about their specific coverage should contact UnitedHealthcare using the phone number on the back of their insurance card. That is the right first call, because only the insurer can say what a particular policy covers.
Several other steps are worth taking in the meantime, none of which require guessing how the negotiation will end.
Confirm which UnitedHealthcare product the household actually has — commercial, Medicare Advantage, or Veterans Community Care Network — since the announced effects differ by product. Check whether the plan has an out-of-network benefit at all, and what the separate out-of-network deductible and out-of-pocket maximum are. Ask directly about continuity-of-care or transition-of-care rights for any treatment already under way, and ask what the deadline is to request them. If the coverage comes through an employer, raise it with the benefits administrator, who may have information about the plan’s options and any employer-level response. And for scheduled, non-urgent procedures in early October, ask both the hospital and the insurer how the claim would be processed if the contract has lapsed by the date of service.
Patients should not read any of this as guidance to delay or forgo care they need, and questions about an individual policy or an individual course of treatment belong with the insurer and the treating clinician rather than with a general account of the dispute.
The parties have until Sept. 30. Until then, the contracts remain in force and commercial UnitedHealthcare members retain in-network coverage at University Hospital and Children’s & Women’s Hospital.