A stalemate between Johns Hopkins All Children's Hospital in St. Petersburg and one of the country's largest private insurers is jeopardizing medical care for some of the area's sickest children. Since negotiations between All Children's and UnitedHealthcare over reimbursement rates for the insurer broke down last month, the hospital is essentially out of financial reach for many families insured by United. That's a terrifying prospect for a family with a sick child, and it's critical that the two sides come back to the table and reach an agreement.
In negotiations that began late last year, All Children's sought a 60 percent increase in reimbursement rates from United, which the hospital says consistently pays less than other private insurance companies and far below market rate. All Children's was willing to agree to a 35 percent increase, but United, which made $13 billion last year, would not go above 20 percent and stopped negotiating. So as of May 11, All Children's is considered out of network for families with health coverage through United — meaning they can still see doctors at All Children's and have procedures there but would have to pay much higher rates. For many, that's a non-starter.
All Children's, a prominent institution in St. Petersburg since 1926, provides specialty care for a multitude of complex pediatric cases. Families throughout Tampa Bay benefit from having specialists close to home, while many more travel from around the state and country to access All Children's care. Seriously ill children typically have teams of doctors and therapists working to make them well, relationships that are carefully cultivated with frightened young patients. Finding a new doctor or an entire new medical team is a harrowing disruption for families already under tremendous stress. Locally, United covers the employees of the cities of St. Petersburg and Tampa, Pinellas County as well as large private employers such as Raymond James Financial. That's what makes the stakes so high in this fight.
All Children's is not the only option in the area — in Tampa, St. Joseph's and Tampa General both have children's facilities that remain in the United network. And under state law, patients currently receiving ongoing treatment cannot be cut off from that care for at least six months. But some services All Children's provides aren't available anywhere else in the region, such as bone marrow transplants, heart transplants and some orthopedic and spine care. The closest alternatives? Gainesville, Orlando or Jacksonville. What also distinguishes All Children's is that while providing highly specialized care, it serves a broad, largely poor population. Some 70 percent of its patient base receives Medicaid. A recent report sponsored by the Children's Hospital Association ranked All Children's fourth among free-standing children's hospitals in providing highly complex care at the lowest cost. To continue providing that care, it must be paid a fair rate.
It is absurd that thousands of Tampa Bay families cannot access the revered children's hospital in their community that has a state-of-the-art facility, a Top 50 national ranking and membership in one of the pre-eminent health systems in Johns Hopkins. What the exact reimbursement rate should be is a matter for the negotiating table, and that's why talks between All Children's and United need to resume immediately. Families are waiting for a resolution. Without one, sick kids will suffer.