United Healthcare - Community Update

Nov/13/2014

There's been a great deal of news coverage of Sarasota Memorial's lawsuit against United Healthcare over the insurance company's attempt to cancel its contract with the hospital. While we are seeking assistance from the court, please know that we also remain in active, daily discussions with United with the sincere hope that we can resolve this situation before it further impacts our community.

We know members of United Healthcare plans have many concerns. We’ve compiled the information below to help answer some of the most frequently asked questions. If you would like additional information or to discuss your concerns with one of our billing advocates, please call our Billing Advocacy Office at (941) 917-1540 or (800) 764-2455 weekdays from 8:00 a.m. to 5:00 p.m. 

Why can’t this situation be resolved?

We’d like to emphasize that these are not routine contract negotiations. We are neither canceling our contract with United nor asking for higher rates. We filed a lawsuit on Oct. 31, 2014 simply to restore the original terms of a contract that was approved by both United and Sarasota Memorial and put into effect Jan. 1, 2014. It was a multi-year agreement that was not due to expire until May 2018.

In July, United stopped honoring the contract by paying lower-than-agreed rates.  Further, they notified SMH that they planned to unilaterally cancel the contract on Dec. 31, 2014 rather than in 2018, even though there was no cancellation provision in the contract.

We see no basis for United’s actions. We had hoped to avoid litigation, but after several months of discussion around the issue, and the termination date nearing, we felt we had to seek court intervention in case it becomes necessary to enforce the terms of the agreement.

Are all of United Healthcare plans affected by this dispute?

All of United’s commercial, Medicare Advantage/Replacement and Medicaid managed care plans could be impacted. If not resolved by Jan. 1, 2015, and if United follows through on its threat to unilaterally cancel the contract, all hospital stays and services at Sarasota Memorial’s main hospital and outpatient campuses and clinics will be considered “out of network.”

The only plans NOT affected are United Medicare Standard Supplement Plans.

Please note we do not have "in-network" contracts with any Medicare "Select" Supplement plans. 

When will my in-network coverage end?

Sarasota Memorial is currently in network and should remain in network until Dec. 31, 2014.  Services on or after Jan. 1, 2015 may be considered out-of-network if we are unable to resolve this dispute.

What happens in emergency situations?

United members do not need to worry about choosing in-network or out-of-network hospitals when seeking emergency care. If it is a true emergency, they should go to the closest ER equipped to handle their condition. There is no authorization needed and the patient's financial responsibility is no higher if they go to an out-of-network ER.

What about Sarasota Memorial’s First Physicians Group? What does this mean to my relationship with my doctor?

Although Sarasota Memorial's First Physicians Group has a separate contract with United that is not part of this dispute, patients seeking services from individual FPG physicians may find the care limited since the majority practice solely at our hospital.

How serious is this dispute? Could it be resolved in the coming days?

This is far from a typical situation – we are not in routine contract negotiations. We had an existing contract and United's breach of that contract is an extremely serious matter that has potentially far-reaching repercussions for everyone involved. 

We want to assure the community that we remain in active, daily discussions with United, and that resolving this dispute before it impacts our community and our patients is our highest priority. While we cannot guarantee that we will be able to reach an agreement today, this week or this month, we are committed to continuing to work with United and to explore and evaluate all options our teams bring to the table. 

What if I’m pregnant or in the middle of a course of treatment?

Pregnant women and children with United managed care plans may be forced to seek hospital care in another county since we are the only hospital in Sarasota County with maternity, inpatient pediatrics and neonatal intensive care services.

There are provisions in state law to ensure continuing care for patients in the midst of treatment. Although there are limitations, as the region’s safety net provider, we will work with patients in these difficult circumstances to ensure they receive the care they need.

Is there anything I can do to change United Healthcare's decision?

We certainly don’t want to force people to switch insurance companies to access our services, but neither do we believe it’s fair to maintain a different set of rules for just one insurance company. You can help by making your voice and opinion heard: 

• Commercial Plan Members

If you are a member of one of United Healthcare’s commercial plans or an employer offering a plan underwritten by United (such as Golden Rule or UMR), you can take a stand and call, write or email United Healthcare to express your concerns. Let them know how you and your colleagues are being affected, and why you feel it is important that Sarasota Memorial remain part of your covered network.

• Medicare Eligible Beneficiaries/Medicare Advantage Members 

For Medicare eligible beneficiaries, the timing is important because Medicare enrollment ends Dec. 7. Those enrolled in or considering United’s Medicare Advantage plans – including AARP’s Medicare Complete – need to understand that Sarasota Memorial may be removed from United’s approved network at the end of this year.

Until this situation is resolved, you may want to consider switching to original Medicare. We accept original Medicare and all original/ standard Medicare supplements.l 

If you prefer a Medicare Advantage/Replacement plan, we accept several other Medicare Advantage plans, including: 

Aetna

Blue Cross and Blue Shield 

BeHealthy (effective Jan. 1, 2015)

Humana Open Access Medicare (PPO) 

It’s important to research your options carefully to ensure you receive the full benefits of your plan and care from the doctor and hospital of your choice.

To learn more, speak with a local Medicare counselor provided to you by the Florida Department of Elder Affairs' SHINE Program. SHINE (Serving Health Insurance Needs of Elders) is a free program that provides one-on-one counseling and information. SHINE services are free, unbiased, and confidential. For assistance, contact the Florida Elder Helpline at 1-800-963-5337, or visit www.floridashine.org.  

Reporting Concerns | PRIVACY POLICY | Terms of Service | Online Bill Pay | Mobile Site | Smartphone App
Site optimized for Chrome or Firefox | Copyright © 2015. Sarasota Memorial Health Care System. All rights reserved.