Wednesday, June 20, 2018
Health

Stalemate between All Children's Hospital, UnitedHealthcare leaves families in a bind

ST. PETERSBURG — Christina and Michael Shreeve were stunned when they received two dozen letters from UnitedHealthcare, each listing a doctor at Johns Hopkins All Children's Hospital who would no longer be "in network."

As a practical matter, the letters mean the Shreeves will need to find new physicians, therapists and lab technicians for their 5-year-old son, who has a rare auto-inflammatory disease.

They can't afford the out-of-network rates at All Children's.

"I've cried more about this than I did when we got the diagnosis," Christina Shreeve said Tuesday. "It took us two years to put together our team of doctors. It runs like a well-oiled machine. I'm not going to get the same quality of care anywhere else."

The Shreeves, who live in Fish Hawk, aren't alone. A stalemate between United — one of the largest health insurance companies in the country — and All Children's could affect thousands of families across the Tampa Bay region.

United provides health insurance for some of the region's largest local governments, including Pinellas County government and the cities of St. Petersburg and Tampa. It is also the primary carrier for Raymond James and several other private employers.

United used to have a contract with All Children's that allowed members to pay in-network rates. But when it came time to renegotiate last fall, All Children's asked United to pony up more money.

"United has lagged way behind the market in terms of the amount they reimburse us for taking care of their children," hospital president Dr. Jonathan Ellen said Tuesday, adding that his hospital handles complex cases that can't be handled elsewhere.

All Children's initially sought a 60 percent increase to keep up with rising health care costs, Ellen said. The hospital later lowered its request to 35 percent. But United would agree to only 20 percent.

United pays All Children's "competitive rates that are in line with other specialty hospitals in the St. Petersburg area," the company said in a statement.

"Despite UnitedHealthcare offering to increase their reimbursement rates by 20 percent," it said, hospital leaders "continue to turn down our offers, insist on a 35 percent raise, and are deferring to an out-of-state consultant to manage the negotiation rather than working directly with our local team to reach a quick resolution."

Ellen said United, which posted more than $13 billion in operating earnings last year, was "making profit at the expense of children."

"If they paid us anywhere near market (rate), I'd take it," he said. "They just aren't negotiating in good faith."

Under state law, patients who were receiving care when the contract was terminated May 11 can continue paying in-network rates for up to six months. Other families with coverage through United can still go to All Children's, but have to pay the more expensive out-of-network rates.

United pointed out that several other local children's hospitals are "in network," including Children's Medical Center at Tampa General Hospital, St. Joseph's Children's Hospital and Shriners Hospital for Children.

News of the stalemate sent shock waves through local governments.

Earlier this month, the city of St. Petersburg sent an email to its 2,600 employees explaining the ramifications. Council member Amy Foster said the development was "causing angst" among workers.

Krista Lemon's son Jackson, who suffers from a rare autoimmune condition and had previously been treated at All Children's, had to go to a different hospital on May 15. The doctors there were "kind and caring," Lemon said, but didn't know how to help her son.

"Families of severely ill children shouldn't have the extra burden of switching care mid-treatment plan," she said.

Shreeve said United offered to extend her in-network rates at All Children's through July 1. She worries it will take months for her son, Gavin, to build relationships with new providers.

"This poor child has been through so much," she said.

Ellen hopes United will reconsider.

"It is not about the money," he said. "It is about fairness and it is about the families."

Times staff writers Charlie Frago and Steve Contorno contributed to this report. Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

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