BayCare vs UnitedHealthcare Puts Docs & Patients in the Middle

A fractious contract dispute between UnitedHealthcare and Tampa Bay’s largest hospital network has heated up, leaving patients stuck in the middle.

BayCare Health System, which includes 11 major hospitals in the Pinellas-Pasco-Hillsborough region, has sent letters to patients informing them that United’s Medicare Advantage plans won’t be acceptable coverage there after Nov. 26, except for emergencies.

Its contract with United is expiring and the Medicare HMO and PPO plans won’t be renewed, says BayCare’s letter from Diane Kazmierski, vice president for managed care at the hospital network.

The letter, dated Oct. 12, suggests “that you consider other Medicare plans for next year to ensure that you will be able to continue with your current care plan with your doctor at BayCare Hospitals.”

The open-enrollment season for 2013 coverage under Medicare began Oct. 15, about the same time the letters arrived in the mail. It ends Dec. 7.

Will dispute fizzle or expand?

Managed-care contract disputes are not uncommon, and they almost always get resolved at the 11th hour. But the timing on this one could be devastating to United if its Medicare members decide they would rather change their insurer than their doctor and hospital.

The four plans listed in the letter are the UnitedHealthcare and UnitedHealthcare AARP plans that carry the brand MedicareComplete. They include two HMOs and two PPOs.

According to figures released by United, that would affect about 63,000 patients. But if the dispute widens to include United’s commercial and Medicaid members in the area, as United spokeswoman Elizabeth Calzadilla-Fiallo said might happen, it could affect nearly half a million.

The only beneficiary of this high-profile argument may be local newspapers, with both sides trying to claim the high ground in full-page ads.

Dispute centers on money.

BayCare Health System’s letter claims that United has delayed or denied $11 million in legitimate claims for Medicare patients over the past four years.

“We cannot allow United to continue to deny claims for services that your physician feels are best for your health,” Kazmierski’s letter states. “You deserve better. We encourage you to let United know that your doctor is the one who makes decisions about your care, not them, and that you will switch to a different insurance since BayCare will no longer be included in their network.”

The letter includes a list of 11 other Medicare plans, with phone numbers provided.

Trying to play catch-up, United declared it has paid its legitimate bills, noting that for the past two years, the American Medical Association rated the company above other national health plans for its timeliness of claim payments and payment accuracy.

The $11 million that BayCare mentioned in its letter “represents less than 1 percent of the total we have paid BayCare for the time period in question,” United’s statement says. “We believe that we have lived up to our American Medical Association rating and will continue to work with BayCare in efforts to resolve the any disagreement they may have with us in that regard.”

Rate increase demands ‘way out’

In an interview, United spokeswoman Elizabeth Calzadilla-Fiallo attributed the current troubles to BayCare’s rate-increase demands. She said they were 23 percent for employer plans, 8 percent for Medicare, and 7 percent for Medicaid and Florida KidCare.

“The rate increases are way, way out there,” she said. “They’re impossible to honor; it would burden our members incredibly as well as employers.”

BayCare spokeswoman Amy Lovett said she couldn’t comment on the rate increases for Medicare and Medicaid, but she said the 23-percent figure on commercial plans “is inaccurate – too high.”

Both companies are getting a lot of calls from patients confused about what’s going on — with reason.

United’s ad this week said it will continue to cover its Medicare Advantage members at BayCare hospitals as they are now – as if the hospitals were part of the network – through the end of 2013.

Calzadilla-Fiallo said the company received permission from federal officials to make that claim. But she conceded that the insurer can’t force BayCare to admit its patients except in emergencies, when the law requires hospitals to provide treatment until the patient’s condition is stable.

BayCare denies manipulating seniors.

Lovett said that as things stood on Thursday, United managed-care members won’t be treated at BayCare hospitals after Nov. 26 except for emergencies. She denied that the hospital network was manipulating seniors to enhance its negotiating strength.

“Our intention is to inform patients of their choices,” she said.

“It’s all just posturing,” said Tampa surgeon Michael Wacylik, the Florida Medical Association’s point man on managed-care issues.

Based on history, he tells his patients the dispute will almost certainly be resolved just before the Nov. 26 deadline, but he wishes it would happen sooner.

“It gets all the patients upset,” he said.

(3) Comments so far...

  1. Good for baycare. UHC does have a higher denial rate that any other insurer we work with. They require more reviews and medical records request than any other carrier. UHC makes health care providers work harder for reimbursements than most all of the other plans we work with. Maybe this dispute will make UHC clean up its claims process for its providers.

  2. It’s about time someone gives UHC a reality check. They are a disgrace to seniors and providers.. They need to be inspected by the commissioner of insurance.

  3. Unfortunately, my employer only uses UHC. I just found out about this yesterday, and I do not want to change doctors. What do I do?

Let us know your thoughts:

By clicking "submit" below, you are agreeing to abide by our comment policy here.

Wish your picture would appear next to your comments here? Upload a picture at Gravatar to make it happen. It's that simple.

Let us show you the goods.

The more we know about each other, the better. Let’s schedule a time to meet and we’ll customize a demo that will reflect the way you practice medicine.

* indicates a required field

Interested in a quote? Let’s get to know each other first.

We’re not for everyone. Let’s schedule a time to talk and find out if we are a fit for you. Then we’ll be able to provide a quote customized for your practice. Let us know the best way to get in touch with you and we’ll make it happen.

* indicates a required field

Is It Worth It?

Why wait for stimulus funding? Calculate your Return on Investment (ROI) today!

What is your Return on EHR?

There are several components to calculating your return on investment (ROI).

There is a revenue side, allowing you to capture charges more accurately, code correctly and reduce payor rejections. There also exist many expense savings, including reduced paper supplies, transcription costs, space savings, and staff efficiency.

If you look at the ROI only as a physician, you may miss the ROI available to you as a business owner… remember, in many cases you are BOTH.

Estimate your Annual Savings with EHR

Try our quick ROI calculator and find out if an EHR may be financially beneficial for you. You’ll get your answer PDQ.

Our formula takes into account industry averages and best practices from various sources, but we’re happy to personalize it for you.

Want more detailed information on savings? Just ask. That’s what we’re here for.

Try our ROI Calculator to determine the
impact our EHR will have on your business:

  • For a more detailed savings breakdown,
    please enter your info below

    * indicates a required field

    Relevant. Interesting.
    Always Fresh.

    Weekly updates from us on the latest EHR news and information to help you navigate the quickly changing world of health care.

    * indicates a required field

    Everyone's doing it.

    Chances are you heard about us from a friend. People like to talk. Keep spreading the word.

    * indicates a required field