UnitedHealthcare tosses 17,500 So. Fla patients out-of-network

17,500 patients with UnitedHealthcare forced to seek care elsewhere or pay higher out-of-pocket costs as UHC and Boca Raton Regional Hospital fail to renew hospital contract

UnitedHealthcare members with employer-sponsored, individual, Medicare Advantage and Medicaid policies are affected as the two fail to negotiate a replacement agreement for the contract that expired in June, 2019.

UnitedHealthcare said if it agreed to the hospital’s demands, its self-funded members would see their healthcare costs rise $3.2 million during the next year for their employees’ healthcare services.    But those employers could call on SurgeryShopper.com to help them contract directly with Baptist Health South Florida or find a replacement that contracts for lower prices than UHC.

According to Maria Todd, our go-to expert on all things related to payer and provider contracting, Baptist Health South Florida allegedly wanted rate increases of 15% which UHC was unwilling (or unable) to afford. “One thing people often don’t appreciate is that rate filings to the Florida Agency for Healthcare Administration (AHCA) must be submitted two years prior to the current contract year. So, if UHC didn’t submit actuarial and underwriting estimates in time, there may not be enough to cover the requested increase. It’s like the money tree that has no leaves left to pick.”  Providers who need an increase in order to maintain in-network agreements should be vigilant and build in rate increases into multi-year or “evergreen” contracts that roll over on the anniversary dates. That way, the health plans are on notice when they do their rate filings 2 years in advance. Without that, assume you got to the orchard too late in the season to pick any more money tree leaves.”

Todd says that hospitals everywhere are in the same boat. It isn’t just a Florida phenomenon. She says that many of her national clients are in renegotiations with UHC and are reeling from some of the new contract rate proposals coupled with UHC’s affiliate providers and new competing acquisitions getting first dibs at the orchard and leaving community providers and critical access hospitals and ASCs to pick from the dead leaves on the ground. 

“I believe the days of wholesale rate negotiations by hospitals and hospital outpatient departments and ASCs are gone. I also see a revolutionary change in the marketplace where self-funded employers are concerned. They may buy locally for emergencies and start steering high-priced services to a select, directly-contracted narrow network of their own choosing. The step after that one is the one that UHC and its contemporaries should be most concerned. The networks’ lucrative network and discount rental and lease payment arrangements will fall out of favor with employers.”

UnitedHealthcare leaves 17,000 So Florida patients without an in-network hospital option. Patients will have to drive a longer distance to access care
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