United Health Care - Network Provider Issues

[oscar]

I looked through this forum for a while this morning, but I didn't see the current issues that United Health Care are having with their network providers discussed anywhere, so I wanted to see what anyone might be able to share relevant information / advice...

I just recently became appointed with United Health Care (Golden Rule) for Major Medical, and while I have liked their products and pricing thus far, I am confused by what is going on between them and their network providers.

I am in Missouri, and two of my prospective clients have told me in the last 2 days that St. Luke's Hospitals (based in KC) are dropping their network association with UHC. I checked on St. Luke's website this morning, and that is in fact true. This is a very large Hospital system and as of February, they will no longer honor UHC as "in network..."

Apparently, the same thing is true of KU Medical Center, although I couldn't confirm that KU Med Center's web-site. Is thiss happening all over the country? Is this something to be extremely concerned about?

Does this all stem from the fact that UHC utilizes the trick-word of "reasonable" (in addition to "usual and customary") in their determination of claims reimbursements?

I saw the news coverage about Oxford Insurance a couple of weeks ago, regarding the supposed "3rd-party" firm that turned out to be an in-house organization that was determining their claim rates... is this the same thing that is going with UHC? I know that they are the same company, with different names, I just don't understand how big this problem really is, or how much bigger it will get?

Should I be wary of quoting their products? I like their rates and United Health Care seems to have quite competitive rates here... I'm just trying to make some sense out of this???

 

[moonlightandmargaritas]

I am in Missouri, and two of my prospective clients have told me in the last 2 days that St. Luke's Hospitals (based in KC) are dropping their network association with UHC. I checked on St. Luke's website this morning, and that is in fact true. This is a very large Hospital system and as of February, they will no longer honor UHC as "in network..."

Apparently, the same thing is true of KU Medical Center, although I couldn't confirm that KU Med Center's web-site. Is thiss happening all over the country? Is this something to be extremely concerned about?

Not to worry, this is common-place "posturing" for negotiating leverage. It happens with just about all carriers in most markets when they are at the end of a contract.

Here in the Tampa Bay area, in the last three years, we've had it with Aetna, UHC and BCBSFL...

Since the hospitals need the insurance company's clients, and the carriers need the hospitals, they will eventually kiss and make up.

 

[oscar]

Thanks so much for the clarification! Understandably, there are a lot of politics between providers and insurers... I guess that I won't worry about it too much for the time being.

 

[Guest]

On the provider side...they are a nightmare to deal with. They have a lot of networks and used to give out multiple provider #s. You will get a referral and have them deny the claim saying you are out of network hoping the Providers do not appeal it. You have to jump through hoops to get things paid. Plus I worked for a Medical Supply Company that stopped accepting them simply because they did not reimburse enough to cover our costs.

I know there is one hospital near Greenville that stopped taking them. I think every company out there deals with providers dropping out or threatening to drop out in hopes of better reimbursement.

 

[motoxxx]

Yep! Just posturing during negotiations. We have a network here in WA that is actually running ads on the radio bad mouthing the insurance company trying to force people to drop their coverage with them. They are bad mouthing the CEO for making $2million a year while the top surgeons are making close to that!

Don't sweat it. They will kiss and make up. It may take a while and each one can come out a little bruised but the perfect deal will be one that neither outfit is very happy with. Just part of the game.