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Contract disputes between hospitals and health plans have become routine, but they tend to be local, affecting a handful of hospitals and the people in the surrounding communities.

This latest one is different. It involves the country’s biggest private health insurer, UnitedHealthcare, and its biggest hospital chain, HCA Healthcare. If they can’t strike a deal on prices by Sept. 1, 38 hospitals and their affiliated physician groups and surgery centers across four states — Texas, Colorado, South Carolina, and New Hampshire — would become out-of-network for UnitedHealthcare members.

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“This very much seems like a battle of the giants, because United: huge, HCA: huge,” said Morgan Henderson, director of analytics and research at The Hilltop Institute, a research group at the University of Maryland, Baltimore County. “This is going to be very interesting to see how this plays out.”

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