By Jason Hines
On August 1, 2025, Capital Women’s Care (CWC), one of the largest OB/Gyn practices in the middle Atlantic region was out of the network with United United, Affecting tens of thousands of women In all Maryland, Virginia, Pennsylvania and Washington DC, the contract dispute between Capital Women’s Care (CWC) and UnitedHealthcare offers a fascinating case study on how price transparency data illuminates real dynamics.
The public battle
Capital Women’s Care, with more than 250 doctors and health professionals, confirmed that his agreement with United Hase Lagaría despite the ongoing negotiations. The practice urged patients to contact UHC to express their concerns about the loss of access to their suppliers.
UnitedHealthcare responded with detailed Public claims on your websiteClaiming that CWC “refused to leave its demands for two -digit price increases” and is “a significantly higher cost today compared to pairs suppliers through Maryland and Virginia.” UHC provided specific examples, claiming that CWC vaginal delivery would cost “more than 120% higher, or at $ 2,600 more, than the average cost of other OB/Gyn suppliers.”
But what reveal the real data transparency data on these competitive statements?
What transparency data shows
Using the Women’s Care Capital negotiated rates of the United Machine -readable files, we analyze a common OB/Gyn procedures sample of the Maryland Rate Data. While this represents only a subset of all procedures and focuses specifically on Maryland’s rates, it provides valuable information about real payment dynamics between these organizations. The data paint a more nuanced image than the public statements of any of the parties suggest.
Data methodology Note: Our analysis examined the negotiated rates for the care of capital women of the files legible by machine publicly available, focusing on Maryland’s suppliers and filtering atypical statistical values (rates of less than 50% ORON 500% of Medicare). We analyzed rates for United and Carefirst in three common OB/Gyn procedures where both payers had sufficient data.
CWC rate in front of other payers
Our analysis of three common OB/Gyn procedures in Maryland reveals that CWC rates with UnitedHealthcare were actually quite fun with other important payers:
For the three procedures where both UHC and Carefirst have negotiated rates with CWC:
- CPT 56515 (Destruction of the vulvar injury): UHC paid $ 401 compared to the $ 617 of Carefirst (53.9% difference)
- CPT 57288 (Honda Operation): UHC paid $ 1,163 compared to $ 1,254 of Carefirst (7.8%difference)
- CPT 58558 (Hysteroscopy): UHC paid $ 2,294 compared to $ 2.318 of Carefirst (1.0%difference)
This sample data suggests that Unitedhealthcare was already obtaining favorable CWC rates compared to other important payers, questioning UHC’s statements about CWC “significantly higher costs.”
Medicare’s reference reality
Both UHC and Carfirst were paying CWC rates well above Medicare in our sample:
- Unitedhealthcare: 143-175% of Medicare rates
- Care: 166-220% of Medicare rates
While the care of the highest rates, the unitedhealthcare rates were still substantial cousins in government reimbursement, a suggestion that the “two -digit increases” requested by CWC could have been more to pay.
IMPORTANT LIMITATION: This analysis is based on a sample of three procedures only in Maryland. An exhaustive analysis would require examining all procedure codes in all markets where CWC operates to completely validate thesis patterns.
The strategic context: the market share is important
Understanding why CWC could have moved away requires examining the position of Unitedhealthcare in the Maryland market. According to KFF data, Unitedhealthcare only has 9% of Maryland’s large group market 2023 shared axis. This relatively small market position CWC CWC significant.
Mathematics to move away:
- UHC represses a small portion of the CWC patient base
- CWC has contracts with larger payers (Aetna, Carefirst, Cigna) that pay higher rates
- The practice serves about 250 suppliers in multiple states
- Moving away from 9% of the market to establish the precedent of fees makes strategic sense
EVALUATION OF PUBLIC CLAIMS OF UNITEDHEALTHCARE
The UHC website makes several specific statements that we can evaluate against transparency data:
Claim 1: “CWC is a higher significant cost compared to pairs suppliers”
Evaluation: partial misleading
While CWC can charge more than some suppliers, our analysis shows that UHC was paying competitive rates compared to other important payers for the same services. The comparison of the “pairs supplier” lacks context on geographical market rates and supplier quality differences.
Claim 2: “two -digit price increases that would make them 30% higher than average”
Evaluation: missing context
This claim does not take into account:
- How current UHC rates compared to other payers
- If the “average” includes lower quality suppliers or differently positioned
- Regional cost variations in the medium expectation market
Claim 3: specific comparisons of procedure costs
EVALUATION: Potntiaty Exact but incomplete
UHC statements about delivery costs can be precise, but do not provide the full market context. Transparency data show a significant rate between payers and procedures, a suggestion that “expense” is relative to the chosen comparison set.
How the transparency of prices changes the game
This dispute illustrates how prices transparency data is remodeling medical care negotiations in several ways:
Informed leverage
Suppliers such as CWC can now see exactly how their rates between payers are compared, allowing more strategic negotiations. CWC knew that they were giving favorable UHC rates compared to Carfirst.
Public responsibility
Both parties made public claims that can now be verified on real negotiated rates. UHC’s statements that CWC is “significantly higher cost” are more nuanced when they are seen against the panorama of complete payers.
Market benchmarking
Transparency data revitalizes that:
- Regional markets have substantial rate variations
- Supplier quality and market position justify rates premiums
- “Caro” is relative to the comparison that is being made
Strategic positioning
For a practice with the position of the CWCS market, maintain the rate discipline between the payers becomes crucial. Acceptance below a payer’s market rates can undermine negotiations with others.
The true winner: market transparency
While patients are trapped in the middle of this dispute, the widest market in the health market benefits from the transparency provided by this conflict. The public availability of real negotiated rates means:
- Patients You can make more informed decisions about suppliers and plans
- Employers You can better evaluate the insurance plan value proposals
- Suppliers You can compare your rates with real market data
- Payers You must justify rate decisions with real data instead of selective comparisons
Looking forward: Lessons for Medical Care Negotiations
The CWC-UHC dispute sacrifices several lessons for future health contract negotiations:
- Price transparency data are now a negotiation tool – Both sides can and use comparisons of real rates to support their positions
- The market share is important in rates negotiations – Maryland’s market share of 9% of UHC limited its leverage against a large and established supplier
- Public relations battles require data support -The claims on “expectations” suppliers can now be verified with real negotiated rates
- The consolidation of the supplier creates negotiation power – Great practices such as CWC can afford to get away from unfavorable contracts
The way to resolution
For this specific dispute, transparency data suggests that both parties have reasonable positions:
- CWC In fact, I was giving UHC favorable rates compared to other payers, justifying your application for increases
- UHC Face pressure to control the costs of the members while maintaining an adequate supplier network
A resolution probably requires:
- UHC recognizing that their current rates were below the market
- CWC acceptance that dramatic rates increases affect patient costs
- Both parties that find an average land that reflects the true market positioning
The availability of real negotiated fees data should, in theory, make these conversations more productive by establishing shared facts on market rates and supplier positioning.
Conclusion
The Women’s Care vs United Capital Contract dispute demonstrates how prices transparency is fundamentally changing health negotiations. While both parties made public claims that support their positions, our analysis of Maryland’s real negotiated tariffs reveals a more complex story where market dynamics, strategic positioning and regional factors play crucial roles.
Takeeways of our data analysis:
- UHC was paying competitive rates compared to other important payers for the procedures we examine
- CWC’s decision to move away makes strategic sense given the limited participation of 9% of UHC Maryland.
- Both payers were paying well above Medicare’s rates, suggestion room for negotiation
IMPORTANT WARNINGS: Our analysis examined only three common procedures of Maryland’s data. A comprehensive evaluation would require analyzing all procedure codes in all markets where CWC operates to completely validate thesis patterns.
As more stakeholders get access to this previously hidden price information, we can expect health contract negotiations to become more data units, transparent and, ultimately, more rational. The true winners will be those who can effectively analyze and act this new transparency to make better decisions about health coverage, the selection of the supplier and the terms of the contract.
I will return to THCB to see the rest of the context of this dispute in part 2. What was the cost of the thesis services of other suppliers in the market?
Jason Hines is CEO or Gigash Which offers market intelligence for the price transparency of AI price. This was first published in his Corporate blog
