UHC Members May Face Surprise Billing at Boca Regional

July 16, 2019 - UnitedHealthcare and Boca Raton Regional Hospital missed their contract renewal deadline and are communicating to UHC members how to avoid surprise bills as the negotiations continue, the Sun Sentinel reports.

The contract ended on June 30 after a month of unsuccessful negotiations. The continued negotiations between payer and provider leave 17,500 members and patients in a precarious position.

Last week, the pair clarified to the local news outlet what UHC will cover at Boca Regional as negotiations continue. BocaCare physicians and Boca Regional urgent care centers are still in the UHC network. However, any tests, treatments, or procedures conducted at the hospital are not covered. 

Bypassing the deadline resulted in higher out-of-pocket costs for any UHC members who went to the Boca Raton Regional Hospital or the affiliated diagnostic imaging center after June 30. However, patients who were receiving care before July 1 will receive in-network benefits for a period of time. 

Boca Raton Regional Hospital joined Baptist Health on July 1 after the UHC negotiations continued to face serious challenges. Baptist Health will take an active role in negotiating an agreement and is currently working with physicians to direct UHC members seeking care to their other Baptist Health South Florida in-network UHC facilities.

“Our intention is to help Boca Raton Regional Hospital reach an agreement with UnitedHealthcare as soon as possible to minimize any inconvenience to affected patients,” Georgi Pipkin, a spokesperson for Baptist Health, told the Sun Sentinel.

Boca Regional has been “aggressively” angling to strike a “more lucrative deal” under the direction of its new chief executive officer, Lincoln S. Mendez.

“Given United’s unwillingness to reimburse Boca Raton Regional Hospital at market competitive rates, a new agreement has not been reached. Boca Raton Regional Hospital would like to continue its participation with United under fair and reasonable terms,” Tom Chakurda, a hospital spokesperson said.

UHC says it is resisting due to the effect Boca Regional’s proposed rate would have on employer group customers and members. It claims Boca Regional is pushing rate increases of over 15 percent in a year.

“We have offered Boca Raton Regional Hospital rate increases that compensate them fairly, but they are seeking significant rate increases…which is simply unsustainable for our employer group customers and the members we serve,” United Healthcare said in a written statement to the Sun Sentinel.

The news that negotiations will continue past the contract’s termination comes less than a month after UHC members in North Carolina recovered their in-network status following a similar dispute.

Harris Regional Hospital, Swain Community Hospital, and Haywood Regional Medical Center announced in mid-April that their negotiations with UHC came to a successful conclusion. Members could now receive care at any of the three hospitals and receive coverage.

According to the local NPR station, members had been paying out-of-pocket for hospital services, including hospital-employed physician visits and OBGYNs, for three months while negotiations continued. The entire process lasted approximately half a year. 

Like Boca Regional, the hospitals claimed that UHC was reimbursing their physicians “’significantly below market average.’” 

And similarly, UHC responded that their rate was fair and that “unfortunately, Duke LifePoint has chosen to put our members in the middle of this and has stalled our negotiation efforts for months, failing to provide us a single proposal or inform us what they are seeking in this negotiation.”

Cases such as these can result in surprise bills when a member does not realize that the hospital they go to is no longer in their network.

More than deductibles, prescription drugs, premiums, or life necessities such as rent, 38 percent of Americans fear they will be unable to afford surprise medical bills, a study by Peterson-Kaiser Health System Tracker found. Fifty percent of participants in a recent Kaiser Family Foundation survey said that protecting people from surprise medical bills should be one of Congress’s top priorities.

READ MORE: Health Plans Ask Congress for Unified Action on Surprise Billing

Even without being placed in jeopardy by contract disputes, Americans face a high chance of receiving surprise medical billing. On average, large employer plans in 2017 saw 18% of all emergency visits and 16% of in-network hospital stays incurred at least one out-of-network charge. 

Approximately a fifth of all emergency department visits involved care from an out-of-network provider in 2018, as Jeanette Thornton, senior vice president of product, employer, and commercial policy of America’s Health Insurance Plans  (AHIP) pointed out in her testimony before the House of Ways and Means.

To assist members and patients in avoiding surprise medical bills, UHC recommended calling the number associated with their health plan, found on the back of their health plan ID card. Boca Regional has posted a list of insurers that it accepts.