UAB Hospital May Stop Accepting Major Carrier Plans

[somarco]

Patients with UnitedHealthcare insurance may soon lose coverage at one of the largest health systems in Alabama due to a contract dispute.

If the University of Alabama at Birmingham Health system doesn't reach a contract agreement with UnitedHealth by July 31, those patients "may be personally responsible" for costs beginning Aug. 1.

"Our goal is to remain a participating provider and continue delivering the highest-quality care to the people of Alabama," Bulgarella said. "We encourage patients and employers to contact United and express the importance of keeping UAB Health System entities in-network."

In a statement to AL.com, United said they are actively negotiating with UAB, but that the health system's demands would "significantly increase premiums and out-of-pocket costs for consumers."

"UAB is already one of the most expensive academic health systems in the Southeast. Despite this, UAB is demanding a double-digit price hike for our commercial plans in one year as well as increases for our Medicare Advantage plans that would make it among the highest-cost providers in our Medicare Advantage network nationally.

UAB may soon stop accepting a major insurance, blaming high denials and low pay

UAB and other hospitals have cited “below-market reimbursement rates, excessive claim denials and delayed payments.”

www.al.com

Perhaps the level of care is justified by the high pricing.

And maybe they wouldn't have this problem if UHC was more reasonable in the claim review process.

 

[Tscholar]

We encourage patients and employers to contact United and express the importance of keeping UAB Health System entities in-network."

I wonder if it will do any good for them to contact UHC. UAB is major in AL because they bought out another major hospital last year, so this is going to really hurt the agents, internal & external if they can't negotiate the contract. It's too bad agents aren't allowed to use the provider network SEP to switch the members.

 

[annon123]

Locally here BC/BS (employer insurance and the biggest one locally - just over half locally have it) and the university system had a dispute. Took nearly 2 years to resolve. For all the patients the university lost to the other 3 systems you'd think that would have motivated them. Nope.

As an aside I had a UHC supp client call this morning who isn't even remotely dual eligible but UHC is sending out junk mail to people with supps telling them if they are dual eligible to switch to their MA. Be interesting to see their next quarterly report.

EDIT -
Doing a bit of research (and using my throwaway phone so my real one doesn't get spammed) it turns out although it looks like UHC is sending them (client took photos and sent them to me - using their logos, etc.) it has not been sent by UHC.

A company that helps set up call centers and sells leads sent it. I was investigating the agent listed on the letter - unusual name so easy to find as he is the operations manager of the company who does this and with respect to medicare specializes in dual complete.

Person who sent it either is in independent agent or a captive agent with a second job (says they are a licensed sales agent on the letter of course who actually knows what is true). The phone number on there is answered saying UHC however the number does not belong to them and is listed as a robocall spam number.

I reported them to UHC. I'd suspect that person is licensed agent selling UHC and is then mining their data base to use in their lead selling business as well as send out the letter my client got. I hope his butt and livelihood burns.

Whom else should I report him to? CMS said not them even though it was a dual complete advantage plan, just UHC.

 

[sman]

Patients with UnitedHealthcare insurance may soon lose coverage at one of the largest health systems in Alabama due to a contract dispute.

If the University of Alabama at Birmingham Health system doesn't reach a contract agreement with UnitedHealth by July 31, those patients "may be personally responsible" for costs beginning Aug. 1.

"Our goal is to remain a participating provider and continue delivering the highest-quality care to the people of Alabama," Bulgarella said. "We encourage patients and employers to contact United and express the importance of keeping UAB Health System entities in-network."

In a statement to AL.com, United said they are actively negotiating with UAB, but that the health system's demands would "significantly increase premiums and out-of-pocket costs for consumers."

"UAB is already one of the most expensive academic health systems in the Southeast. Despite this, UAB is demanding a double-digit price hike for our commercial plans in one year as well as increases for our Medicare Advantage plans that would make it among the highest-cost providers in our Medicare Advantage network nationally.

UAB may soon stop accepting a major insurance, blaming high denials and low pay

UAB and other hospitals have cited “below-market reimbursement rates, excessive claim denials and delayed payments.”

www.al.com

Perhaps the level of care is justified by the high pricing.

And maybe they wouldn't have this problem if UHC was more reasonable in the claim review process.

Just got a phone call today from a client over in Alabama super worried about this because she has UHC.......Med Supp. I assured her she had nothing to worry about.

 

[somarco]

@Tscholar the problem here is not one sided (in spite of the spin in the linked article).

This is akin to a collective bargaining agreement negotiation. Each side wants what is best for them and the patient get's squeezed.

More times than not, these negotiations go down to the wire with both sides making concessions at the 11th hour. Of course in the interim there is a lot of posturing, like two bucks snorting and pawying the dirt, vying for territory and/or the attention of a doe.

This creates a lot of angst for patients with ongoing treatment or scheduled surgery.

Frankly, neither side cares about agents or the client/patient.

It is crap like this that has formed my disdain for managed care plans. You don't have this kind of problem with OM.

 

[somarco]

UHC is sending out junk mail to people with supps telling them if they are dual eligible to switch to their MA.

CMS needs to made aware of this . . .

 

[axeman462]

@Tscholar the problem here is not one sided (in spite of the spin in the linked article).

This is akin to a collective bargaining agreement negotiation. Each side wants what is best for them and the patient get's squeezed.

More times than not, these negotiations go down to the wire with both sides making concessions at the 11th hour. Of course in the interim there is a lot of posturing, like two bucks snorting and pawying the dirt, vying for territory and/or the attention of a doe.

This creates a lot of angst for patients with ongoing treatment or scheduled surgery.

Frankly, neither side cares about agents or the client/patient.

It is crap like this that has formed my disdain for managed care plans. You don't have this kind of problem with OM.

yeah, instead of the hard quick squeeze, you got the slow suffocating death from OM payments not keeping up with inflation and forcing doctor offices to make tough decisions year over year like cutting staff, getting bought out by big medical groups and cutting quality time with patients so they can fit more customers into their already busy day. Or in some cases, forcing doctors to commit fraud/waste/abuse so they can get compensated enough to stay in business.

Don't fool yourself, neither system is right. The whole thing needs to be gutted and completely overhauled.

 

[annon123]

CMS needs to made aware of this . . .

Oops I left out that they had an AARP/UHC supp (because they believed that since it had the AARP name it was "the best". Sigh. Easy sale but I couldn't get them to understand it was just a royalty arrangement and not an endorsement).

 

[billyb]

My 90 year old mother just had a heart valve replaced at UAB. Thankfully she has a Plan F Medicare Supplement. She will not owe a dime.

I looked at a few of her EOB'S. Medicare on average approves about 15% of what is billed.

 

[sman]

Don't fool yourself, neither system is right. The whole thing needs to be gutted and completely overhauled.

Well, one side wants to change it to single payer. It's the Cloward-Piven Strategy. Overwhelm the system and then make the government the "answer".