By Mark Tosczak
If you get your health insurance — including Medicare Advantage policies — from UnitedHealthcare, you may want to double-check before you head to your local hospital this holiday season.
Several Duke LifePoint hospitals are in contract negotiations with the insurer and are at risk of being out of network by year’s end. Two of them — Maria Parham Medical Center and Person Memorial Hospital — are out of contract now.
The hospitals say UnitedHealthcare’s reimbursements are too low; UnitedHealthcare says acquiescing to hospital demands would cost millions of dollars more.
“UnitedHealthcare pays Frye Regional below market average for hospital and physician services,” Frye Regional Medical Center Communications Manager Amanda Brasier said in an emailed statement. “Our current contract is not sustainable.”
Cole Manbeck, a spokesman for UnitedHealthcare, said in an email that the cost of care at Frye Regional would increase by $5.4 million over three years for the company’s employer-sponsored and individual health plans, including $4 million in increases in the first year.
“Accepting DLP’s proposal would have a direct financial impact on all those members who rely on us to provide affordable, quality care, as well as their employers who have committed to providing competitive medical benefits,” Manbeck said.
Frye Regional’s Brasier said that “a new contract will give us the ability to expand and enhance patient services and recruit and retain high-quality physicians and clinicians.”
Five hospitals still negotiating
At least five Duke LifePoint hospitals are renegotiating their contracts with UnitedHealthcare: Frye Regional in Hickory, Maria Parham Medical Center in Henderson, Person Memorial Hospital in Roxboro, Central Carolina Hospital in Sanford and Rutherford Hospital in Rutherfordton.
Maria Parham’s contract ended Dec. 1 and Person Memorial’s on Dec. 15. The other three hospitals’ contracts with UnitedHealthcare end Jan. 1. Once the contracts end, UnitedHealthcare patients who go to these hospitals will have to pay out-of-network rates, which usually means higher costs.[sponsor]
Across all five hospitals, Manbeck said, Duke LifePoint’s demands would increase costs by $11.3 million over three years for employer-sponsored and individual plans. In addition to commercial insurance plans used by employers, the contract talks also cover UnitedHealthcare Medicare Advantage plans at all hospitals except Maria Parham.
The hospitals have been sending letters to patients notifying them of the possibility that they could be out-of-network for United Healthcare.
“We know this situation will cause concern for our patients, and we are committed to helping them understand their options,” said Person Memorial CEO David Ziolkowski in an emailed statement. “We have reached out to patients by mail and encourage patients who have questions to call our patient financial services team at 1-336-503-5699.”
Ziolkowski also said that although the hospital’s contract ended Dec. 15, its physician groups will remain in-network until Jan. 1.
Showdowns between hospitals and insurers over reimbursements are not uncommon. In October 2017, Asheville-based Mission Health ended its contract with Blue Cross and Blue Shield, the state’s largest insurer, leaving some 260,000 people in western North Carolina without access to Mission facilities across the region for a time.
But two months later the two sides announced they’d reached a new agreement, and by Dec. 15 Blue Cross members could use Mission facilities at in-network rates again.
Duke LifePoint is a joint venture between Brentwood, Tenn.-based LifePoint Health Inc. and Duke University Health System. In November, LifePoint merged with RCCH HealthCare Partners, also based in Tennessee. RCCH is owned by investment funds that are managed by private equity giant Apollo Global Management.