Tuesday, September 18, 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.

Comments
Watchdog slams safeguards for foster kids on psych drugs

Watchdog slams safeguards for foster kids on psych drugs

WASHINGTON — Thousands of foster children may be getting powerful psychiatric drugs prescribed to them without basic safeguards, says a federal watchdog agency that found a failure to care for youngsters whose lives have already been disrupted...
Published: 09/17/18
Doctors dismissed her, but she turned out to be right after years of needless suffering

Doctors dismissed her, but she turned out to be right after years of needless suffering

The prominent New York City gynecologist didn’t bother to conceal his disdain."Stop practicing Google medicine," Lina Kharnak remembers the doctor chiding her when she asked about a possible cause of her worsening leg and back pain. The disease about...
Published: 09/16/18
Updated: 09/17/18
Tampa General Hospital’s East Pavilion advised not to use running water after water main break

Tampa General Hospital’s East Pavilion advised not to use running water after water main break

Since Saturday morning, patients and staff in Tampa General Hospital’s East Pavilion and Rehabilitation Center have been advised against using running water.As of Sunday afternoon, it was not known when the recommended ban would be lifted.According t...
Published: 09/16/18
Anger management: Learn healthy ways to handle it, and unlearn bad behavior

Anger management: Learn healthy ways to handle it, and unlearn bad behavior

What makes you mad? Dropping your new phone in the toilet — after deciding not to take the extra coverage that would have replaced it? Being cut off in traffic? Having a parking place "stolen" from you? Doing dishes after shopping for and cooki...
Published: 09/14/18
Red Tide outbreak can be particularly bad for people with asthma or allergies

Red Tide outbreak can be particularly bad for people with asthma or allergies

The toxic algae bloom known as Red Tide has left a trail of dead fish in its wake up the western coast of Florida. The bloom that had been wreaking havoc on our southern neighbors has now made its way to the Tampa Bay area. High concentrations of the...
Published: 09/14/18
In Florida and everywhere, a big shift is underway. It’s changing the way we go to the doctor.

In Florida and everywhere, a big shift is underway. It’s changing the way we go to the doctor.

The health care business in Florida and across the nation is the midst of monumental change as insurers, hospital chains and even retailers begin to venture outside their traditional roles. Hospitals are getting into the insurance end of the busines...
Published: 09/17/18
Calling teen vaping ‘epidemic,’ officials weigh flavor ban

Calling teen vaping ‘epidemic,’ officials weigh flavor ban

WASHINGTON — U.S. health officials are sounding the alarm about teenage use of e-cigarettes, calling the problem an "epidemic" and ordering manufacturers to reverse the trend or risk having their flavored vaping products pulled from the market. The w...
Published: 09/12/18
Doctors explore lifting barriers to living organ donation

Doctors explore lifting barriers to living organ donation

WASHINGTON — Surgeons turned down Terra Goudge for the liver transplant that was her only shot at surviving a rare cancer. Her tumor was too advanced, they said — even though Goudge had a friend ready to donate, no matter those odds. "I have a living...
Published: 09/10/18
Florida has more people using Obamacare than any other state. Will that continue in 2019?

Florida has more people using Obamacare than any other state. Will that continue in 2019?

With just about two months to go before the start of open enrollment for the Affordable Care Act, local advocates say they are worried they won’t have nearly enough resources to get the word out to consumers about some confusing changes this year. Mo...
Published: 09/06/18
Updated: 09/07/18
Airport security trays carry more cold germs than toilets, study finds

Airport security trays carry more cold germs than toilets, study finds

LONDON — Airport security is there to protect you, but it may also give you the sniffles — or worse.To all the places and surfaces we’ve been warned are teeming with germs or bacteria — your pets, the subway seat, airplane cabins, the ATM — add the a...
Published: 09/05/18