Wednesday, April 25, 2018
Health

Seniors caught in Medicare dispute between BayCare health system and UnitedHealthcare

Tampa Bay's biggest hospital group and one of its biggest health insurers are at war, and thousands of Medicare patients are nervously watching, wondering if they could be collateral damage.

It's a battle being waged in full-page newspaper ads and a letter campaign, and it has erupted just as seniors are studying their Medicare options for next year.

BayCare Health System says UnitedHealthcare owes it $11 million in unpaid claims and needs to increase its reimbursement rates, or else its Medicare Advantage customers can't use some of the area's most popular hospitals.

United says BayCare is throwing its weight around to win contract concessions that will only increase costs to consumers.

Medicare supplemental plans offered by United would not be affected even though two were mentioned in the BayCare ad.

Nearly 30,000 area seniors are enrolled in a United Medicare Advantage plan, including HMOs and PPOs. Some of the plans bear the AARP name.

Last week, BayCare ran a full-page ad in the Tampa Bay Times and sent letters to patients that said United Medicare Advantage patients will no longer be able to use BayCare facilities — including St. Anthony's, St. Joseph's, Morton Plant and Mease hospitals — after Nov. 26. One exception: emergency rooms, which are open to all under federal law.

United fired back this week with its own full-page ad in the Times telling customers not to panic. The insurer promised to honor claims at BayCare facilities through Dec. 31, 2013, for Advantage members.

The corporate warfare has consumers confused and concerned.

Maureen Dabeck, a 72-year-old Safety Harbor resident, is enrolled in the United Medicare PPO. After receiving a letter from BayCare last week, she's been worrying over losing her physician who works in the BayCare Health System.

"My son tells me, 'Don't worry. They're just trying to get United off the dime,' " she said. "It's upsetting because you don't stop and think they're just using this in their negotiations. I took it for face value."

BayCare president and CEO Steve Mason said Thursday that, despite what the United ad says about honoring claims through December 2013, the hospitals in his system won't take United Medicare Advantage plans after next month.

"We don't have a contract now from United that is a fair contract, with fair pricing," Mason said. "We take this whole issue seriously because we know there may be some inconveniences to our patients."

A BayCare spokeswoman said she couldn't reveal how much of an increase is being sought.

But a United spokeswoman said BayCare wants 8 percent higher reimbursement rates for Medicare Advantage plans than they have been getting.

"That's BayCare's choice,'' United's Elizabeth Calzadilla-Fiallo said of the health system's declaration that it won't take United customers after next month. "It's their choice to turn them away."

Bruce Rueben, president of the Florida Hospital Association, said an 8 percent increase would be a reasonable request because Medicare rates aren't adequate.

"A hospital can't continue to provide care if it doesn't get its costs covered," he said.

BayCare, a private, not-for-profit, dominates more than one-third of the regional hospital market. In recent months, it has announced plans to expand into Polk and Sarasota counties.

That kind of clout can make a health system a "must-have" for insurers in order to win customers. It also can mean the power to demand higher payments, which can lead to higher prices for consumers.

Seniors may be only the first wave of consumers affected by the dispute.

BayCare is seeking a 23 percent increase in rate payments on private, employer-provided plans, said United's Calzadilla-Fiallo. That big an increase would have to be passed on to patients she said, calling it unacceptable to United.

Why is BayCare playing hardball? BayCare told patients in letters that United has failed to pay $11 million in claims, some of them four years old.

"We cannot allow United to continue to deny claims for services that your physician feels are best for your health. You deserve better,'' it read.

In an interview, Mason declined to comment on the $11-million figure, saying that attorneys were reviewing it. United said that amount is less than 1 percent of claims it has paid in the past four years. The insurer will "continue to work with BayCare in efforts to resolve any disagreement they may have with us in that regard,'' Calzadilla-Fiallo said.

Jane Pictor, 69, of Palm Harbor has a United Medicare PPO. So does her 99-year-old mother-in-law. She said she felt like patients are being used.

"I understand contract negotiations," she said. "This is a little bit more serious in that you are dealing with patients' health."

Art Pollock, a 65-year-old Dunedin resident, spent much of Thursday on the phone with United, only to learn his supplemental Medicare plan would not be affected by the dispute, despite BayCare's claims in its newspaper ad.

"Very misleading," he said.

Counselors at a consumer assistance program called SHINE, or Serving Health Insurance Needs of Elders, have been fielding calls about the dispute.

Their free, unbiased advice: Wait and see.

"Sit calm and wait if you do not wish to change your plan," said Janet Mills, volunteer coordinator at the service, run through the Florida Department of Elder Affairs. The dispute may end before Dec. 7, when seniors must choose a Medicare plan.

Cynthia Dean received the BayCare letter, even though she no longer has a United plan.

She dropped it last year on the advice of her doctors, who mostly work out of St. Anthony's Hospital in St. Petersburg. They told her the insurer had a reputation for poor payments.

"This whole system, it's a minefield," Dean said.

As the services coordinator at the Gulfport Senior Center, she hears frequently from seniors confused by advertising in the enrollment period for Medicare.

"It is very, very difficult ,'' she said, "because the choices are so wide and varied and there are so many companies out there."

-----

This story has been updated to reflect the following correction:

BayCare Health System officials say that its physicians who contract with United Healthcare Medicare Advantage plans will continue to take those patients after Nov. 26, though its hospitals and other facilities will not.

Jodie Tillman can be reached at [email protected] Letitia Stein can be reached at [email protected]

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