Private equity firms say they bring efficiency and scale to healthcare. But for many patients, especially women seeking OB/GYN care, the experience can feel very different. When contract disputes erupt between insurers and large physician groups, it’s often pregnant women and those managing chronic conditions who are caught in the middle.
Consider what’s been happening on the East Coast with practices tied to private equity-backed Unified Women’s Healthcare, one of the largest OB/GYN management platforms in the country.
Unified has built a significant footprint, particularly in the Mid-Atlantic. In Maryland, D.C., and Virginia, its affiliated practices, such as Capital Women’s Care, span dozens of locations and serve tens of thousands of patients. That kind of scale gives Unified real negotiating power. But it also means that when disputes happen, the fallout is widespread.
Research published in JAMA Internal Medicine found that private equity investment in women’s health—including OB/GYN practices—accelerated sharply in the late 2010s, with major platforms expanding across multiple states. Other reviews of private equity in healthcare have linked this model to higher costs and increased consolidation, raising concerns about how financial incentives shape provider behavior.
In 2025, Capital Women’s Care “went out of network” with UnitedHealthcare in a contract negotiation. That means patients were suddenly told their doctors would no longer accept their insurance. For pregnant women, this wasn’t a routine inconvenience, it was a crisis. They faced the possibility of switching providers mid-pregnancy or paying significantly more out of pocket to stay with doctors they trusted.
After months of disruption, the two sides reached a deal but not before Unified Women’s Healthcare had squeezed out higher fees. Access to care had become leverage in a financial negotiation.
A similar dynamic played out in the Carolinas, where a Unified-affiliated network clashed with Cigna. State officials even stepped in, urging both sides to resolve the dispute as patients reported confusion and fear about losing access to care. Again, the standoff wasn’t just about reimbursement rates. It was about who bears the cost and the risk when negotiations break down.
Unified isn’t alone in this approach. Across the country, large provider groups and health systems are increasingly willing to “go out of network” to pressure insurers into higher payments, engaging in high-profile disputes with major insurers, sometimes lasting months. In each case, patients are warned they could lose in-network access, even as both sides claim to be fighting for affordability.
What’s different about private equity-backed physician groups is the financial model behind them. These firms are often under pressure to deliver strong returns within a defined timeframe. That can create incentives to push aggressively on reimbursement rates, using scale and consolidation as leverage. In specialties like OB/GYN, where continuity of care is critical and switching providers can be particularly disruptive, that leverage becomes even more powerful.
For women in particular, the stakes are high. OB/GYN care isn’t easily deferred or replaced. Pregnancy doesn’t pause for contract negotiations. Preventive care, cancer screenings, and management of chronic conditions all depend on stable access to providers. When that access becomes a bargaining chip, it raises uncomfortable questions about priorities in the healthcare system.
Unified’s growing presence on the East Coast means these disputes can affect entire communities at once. At a national level, these standoffs are becoming more common, not less. Consolidation among providers has turned contract negotiations into high-stakes brinkmanship in pursuit of profit.
If there’s a lesson here, it’s that scale alone doesn’t guarantee better care. When financial strategies take center stage, the patient experience can become secondary. In the end, healthcare isn’t just another market. And patients shouldn’t be treated like bargaining chips.
Jason Altmire is an adjunct professor of healthcare management at the Texas Tech University Health Sciences Center. He has been an executive in both the hospital and health insurance industries, and from 2007 to 2013 served three terms in the U.S. House of Representatives.
