On August 1, 2025, Capital Women's Care (CWC), one of the largest OB/GYN practices in the Mid-Atlantic region went out-of-network with UnitedHealthcare, affecting tens of thousands of women across Maryland, Virginia, Pennsylvania, and Washington D.C. The contract dispute between Capital Women's Care (CWC) and UnitedHealthcare offers a fascinating case study in how price transparency data can illuminate the real dynamics behind these high-stakes negotiations.
Capital Women's Care, with more than 250 physicians and healthcare professionals, confirmed that its agreement with UnitedHealthcare would lapse despite ongoing negotiations. The practice urged patients to contact UHC to voice their concerns about losing access to their providers.
UnitedHealthcare fired back with detailed public claims on their website, alleging that CWC "refused to move off its demands for double-digit price hikes" and is "significantly higher cost today compared to peer providers throughout Maryland and Virginia". UHC provided specific examples, claiming that a vaginal delivery from CWC would cost "more than 120% higher – or over $2,600 more – than the average cost of other OB/GYN providers".
But what does the actual price transparency data reveal about these competing claims?
Using Capital Women's Care's negotiated rates from UnitedHealthcare's own machine-readable files, we analyzed a sample of common OB/GYN procedures from Maryland rate data. While this represents only a subset of all procedures and focuses specifically on Maryland rates, it provides valuable insights into the real payment dynamics between these organizations. The data paints a more nuanced picture than either party's public statements suggest.
Data Methodology Note: Our analysis examined negotiated rates for Capital Women's Care from publicly available machine-readable files, focusing on Maryland providers and filtering out statistical outliers (rates below 50% or above 500% of Medicare). We analyzed rates for both UnitedHealthcare and CareFirst across three common OB/GYN procedures where both payers had sufficient data.
Our analysis of three common OB/GYN procedures in Maryland reveals that CWC's rates with UnitedHealthcare were actually quite competitive compared to other major payers:
For the three procedures where both UHC and CareFirst have negotiated rates with CWC:
This sample data suggests UnitedHealthcare was already getting favorable rates from CWC compared to other major payers, calling into question UHC's claims about CWC being "significantly higher cost."
Both UHC and CareFirst were paying CWC rates well above Medicare in our sample:
While CareFirst paid higher rates, UnitedHealthcare's rates were still substantial premiums over government reimbursement, suggesting the "double-digit increases" CWC requested may have been attempts to align with market rates other payers were willing to pay.
Important Limitation: This analysis is based on a sample of three procedures in Maryland only. A comprehensive analysis would require examining all procedure codes across all markets where CWC operates to fully validate these patterns.
Understanding why CWC might have walked away requires examining UnitedHealthcare's position in the Maryland market. According to KFF data, UnitedHealthcare holds only 9% of Maryland's large group market share as of 2023. This relatively small market position gave CWC significant leverage.
The Math of Walking Away:
UHC's website makes several specific claims that we can evaluate against transparency data:
Assessment: Partially Misleading
While CWC may charge more than some providers, our analysis shows UHC was paying competitive rates compared to other major payers for the same services. The "peer provider" comparison lacks context about geographic market rates and provider quality differences.
Assessment: Missing Context
This claim doesn't account for:
Assessment: Potentially Accurate but Incomplete
UHC's claims about delivery costs may be accurate, but they don't provide the full market context. The transparency data shows significant rate variation across payers and procedures, suggesting that "expensive" is relative to the comparison set chosen.
This dispute illustrates how price transparency data is reshaping healthcare negotiations in several ways:
Providers like CWC can now see exactly how their rates compare across payers, enabling more strategic negotiations. CWC knew they were giving UHC favorable rates compared to CareFirst.
Both parties made public claims that can now be fact-checked against actual negotiated rates. UHC's claims about CWC being "significantly higher cost" are more nuanced when viewed against the full payer landscape.
The transparency data reveals that:
For a practice with CWC's market position, maintaining rate discipline across payers becomes crucial. Accepting below-market rates from one payer can undermine negotiations with others.
While patients are caught in the middle of this dispute, the broader healthcare market benefits from the transparency this conflict provides. The public availability of actual negotiated rates means:
The CWC-UHC dispute offers several lessons for future healthcare contract negotiations:
For this specific dispute, the transparency data suggests both parties have reasonable positions:
A resolution likely requires:
The availability of actual negotiated rate data should, in theory, make these conversations more productive by establishing shared facts about market rates and provider positioning.
The Capital Women's Care vs UnitedHealthcare contract dispute demonstrates how price transparency is fundamentally changing healthcare negotiations. While both parties made public claims supporting their positions, our analysis of actual negotiated rate data from Maryland reveals a more complex story where market dynamics, strategic positioning, and regional factors all play crucial roles.
Key takeaways from our data analysis:
Important caveats: Our analysis examined only three common procedures from Maryland data. A comprehensive evaluation would require analyzing all procedure codes across all markets where CWC operates to fully validate these patterns.
As more stakeholders gain access to this previously hidden pricing information, we can expect healthcare contract negotiations to become more data-driven, transparent, and ultimately more rational. The real winners will be those who can effectively analyze and act on this new transparency to make better decisions about healthcare coverage, provider selection, and contract terms.
For healthcare organizations navigating similar negotiations, tools like Gigasheet make it possible to analyze massive price transparency datasets and understand true market positioning - turning transparency requirements from compliance burden into competitive advantage.