Customers of UnitedHealthcare insurance could lose access to the region's largest hospital system if a deal is not reached over reimbursement rates before the end of the month.
The high-stakes standoff between United and BayCare Health System initially threatened access for thousands of seniors enrolled in United's Medicare Advantage plans. But the dispute has now expanded to coverage for people who get their insurance through employer-provided United plans, as well as those on United's Medicaid plans.
All told, more than 400,000 Tampa Bay area United customers are affected by the dispute, said United spokeswoman Elizabeth Calzadilla-Fiallo.
United sent out letters this week to customers with employer-provided plans saying BayCare intends to withdraw from the insurer's network as of Nov. 26, when the current contract ends.
In addition, the nine physician groups owned by BayCare — such as the primary care groups at Morton Plant Mease and St. Anthony's and Suncoast Medical Clinic— would leave the system, the letter says.
United says it has guidelines in place so customers who are being treated for ongoing conditions at BayCare facilities or with its doctors can continue that treatment at the in-network benefit level. The insurer recommends customers call United to see if they qualify.
State and federal laws also guide continuation of treatment, said BayCare spokeswoman Amy Lovett.
A pregnant woman who has started seeing a BayCare doctor, for instance, may or may not continue as an in-network patient, depending on such factors as how far along she is, Lovett said.
"It's difficult to make a global statement about it," she said.
The dispute dates to May when negotiations over several lines of business, including Medicare Advantage and employer group accounts, took a wrong turn.
BayCare says UnitedHealthcare owes it $11 million in unpaid claims and refuses to pay "fair" reimbursement rates. United says BayCare is throwing its weight around to win unreasonable rates that will only increase costs to consumers.
BayCare began running newspaper ads early last month saying 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 — for anything but emergency care after Nov. 26. United answered with its own full-page ads.
Lovett said BayCare wanted to get word out to Medicare patients so they were fully informed before selecting their plans, as it is currently open-enrollment season. She said officials had hoped that in the meantime, the two sides would get the employer-based side worked out.
"We're been hopeful we could resolve the other products," she said.
Though they could no longer use BayCare hospitals and facilities if an agreement isn't reached, Medicare Advantage patients could continue seeing BayCare physicians, Lovett said. She said only those United customers with employer-based insurance would lose in-network benefits with the physician groups.
Also on Thursday, United announced it was expanding access to Florida Hospital locations around the bay area for its Medicare Advantage customers.
As for its relationship with Tampa Bay's biggest hospital system? Though most similar contractual disputes get resolved — and without full-page newspaper ads — neither United nor BayCare is giving positive signals.
"We are not hopeful," Lovett said.
Jodie Tillman can be reached at [email protected] or (813) 226-3374.
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