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If Florida Hospital drops United Healthcare, what to do?
Jul 27, 2010 (The Orlando Sentinel - McClatchy-Tribune Information Services via COMTEX) --
While officials from United Healthcare and Florida Hospital are deadlocked in contract negotiations, thousands of Central Floridians are waiting in a health-care limbo.
If the two health-care giants cannot break their impasse by the Aug. 15 deadline, United Healthcare customers face going elsewhere to receive in-network coverage for nonemergency health care.
Q. With the contract deadline three weeks away, what should consumers do?
Start doing your homework now so you're prepared if the two sides can't agree. Some experts say you should call your doctors and ask whether they are employed by Florida Hospital -- and whether they have hospital privileges at other hospitals. If so, find out which hospitals.
United Healthcare customers should go to the insurer's website (myuhc.com) or get a copy of the network providers from your company's human-resources department, suggested Andria Herr, a local insurance-company executive. Start looking for doctors who practice at other hospitals.
"In almost all instances, there are alternatives," Herr said. "Frankly, consumers should be doing this already: researching alternatives before they undergo treatment."
However, keep in mind that these are negotiations, and both sides could be bluffing.
"These are corporate games of 'chicken,' and we're the pawns in the game," said Bill Newton, executive director of the Florida Consumer Action Network, an affiliate of the Consumer Federation of America. "Ultimately, they will work it out. It's about their profits, one way or another, and the chances of them actually dumping that many customers are pretty darned slim. This is all like a big game of poker."
Q. If we can no longer go to Florida Hospital, what hospitals are still in the network?
A. You will still be able to receive care at other United network hospitals: Arnold Palmer Hospital for Children, Orlando Regional Medical Center, Winnie Palmer Hospital for Women & Babies, Osceola Regional Medical Center in Kissimmee, Central Florida Regional Medical Center in Sanford, South Lake Hospital in Clermont, Halifax Medical Center in Daytona Beach, Orlando Health Lucerne Medical Center in Orlando, Dr. P. Phillips Hospital in Orlando, Health Central in Ocoee, Bert Fish Medical Center in New Smyrna Beach, St. Cloud Regional Medical Center in St. Cloud, South Seminole Hospital in Altamonte Springs and Leesburg Regional Medical Center in Leesburg.
Q. What if there's an emergency and the closest hospital is one of Florida Hospital's 18 hospitals?
A. Emergency treatment will still be covered at in-network prices, said Florida Hospital spokeswoman Samantha O'Lenick.
Q. What if I'm already undergoing treatment at Florida Hospital?
A. For questions about continuity of care, including if you have an upcoming elective procedure scheduled, United members should call the toll-free customer-service number on their health-insurance ID card. You can discuss your situation directly with a United Healthcare representative, said Daryl Richard, a United Healthcare vice president.
Some patients will qualify for "continuing care." For instance, a pregnant woman in her third trimester will not have to schedule her birth at another hospital or find another obstetrician. Likewise, cancer patients undergoing treatment will be treated at in-network rates.
However, those cases will be considered on a case-by-case basis by a team of doctors from Florida Hospital and United Healthcare staffers.
Q. How do I know whether my doctor is one of those 450 doctors employed by Florida Hospital?
A. Call your doctor's office and ask whether he or she is employed by Florida Hospital.
Q. What about senior citizens enrolled in United Healthcare's Secure Horizons or EverCare plans?Does this affect them?
A. "United Healthcare will continue to provide its EverCare and Secure Horizons members with in-network benefits coverage for access to Florida Hospital facilities even if Florida Hospital terminates with us on Aug. 15," said Richard of United Healthcare. Although Secure Horizons is technically only under contract at Florida Hospital Zephyrhills, United Healthcare has been paying in-network benefits for Secure Horizon members at all Florida Hospital facilities, he said, and will continue to do so after Aug. 15.
Q. What about seniors who have purchased Medigap (or supplemental Medicare) insurance policies from United -- such as the policies sold through AARP?
A. Seniors who have Medigap policies from United Healthcare are not affected by the contract dispute because their primary insurer is Medicare -- not United Healthcare. They can go to any doctor or hospital that accepts Medicare patients.
Q. How many people does this affect?
A. United Healthcare represents more than 400,000 Central Florida consumers in 170,000 households. Those customers reside in nine counties -- Orange, Osceola, Seminole, Lake, Volusia, Flagler, Hardee, Highlands and Pasco -- and work for employers such as Siemens, Orange County government, city of Orlando, Seminole County schools and the Orlando Sentinel.
For Florida Hospital's network of hospitals, United Healthcare customers make up 8 percent of the hospital chain's business, O'Lenick said.
Last year, a study done by consumer organization Health Care for America Now reported that United Healthcare and Blue Cross and Blue Shield of Florida dominate the Orlando market. Together, the two insurers represent about 45 percent of the Orlando-Kissimmee market, the report said.
Q. What are the chances that United Healthcare and Florida Hospital will come to an agreement before Aug. 15?
A. No one is sure. In recent years, Florida Hospital has played hardball with insurance giants such as Cigna, Aetna and Blue Cross andBlue Shield of Florida.
Q. I'm mad about this situation. Whomcan I call?
A. Want to voice a complaint or ask a question? Call United Healthcare at 1-800-899-6500 or Florida Hospital's managed-care department at 1-866-338-7494.
Be sure to complain to both sides, said Newton of Florida Consumer Action Network.
"You should complain about their tactics," Newton said. "Tell them to grow up and work it out."
Linda Shrieves can be reached at lshrieves@orlandosentinel.com or 407-420-5433.
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