By Amber Jurgensen | Associate Editor
Unable to reach an agreement for a new contract, BayCare Health System, which includes South Florida Baptist Hospital, no longer will be a participating provider with United Healthcare plans that include commercial, Medicare, Medicaid and Florida Healthy Kids.
According to BayCare, United terminated BayCare physician groups from participation in United’s commercial and Medicaid networks on Oct. 24. BayCare’s hospitals, facilities, home-care services and laboratories no longer will be a participating provider in United’s provider network for Medicare Advantage, Medicaid and commercial products.
The changes will begin Nov. 26.
However, officials from United said BayCare came to United to terminate the plans a year earlier than scheduled. The current contract includes a three-year agreement on payment rates, which was effective through May 2013.
Contract negotiations could not be reached, because BayCare is requesting a 22% rate increase for hospital services on employer-sponsored plans — 8% above what Medicare pays for United’s Medicare customers in the Medicare Advantage plans and 5.5% above what Medicaid pays for United’s Medicaid customers, according to United. United spends about $330 million annually with BayCare. The proposed measures from BayCare comes to about a $50 million increase by the end of 2013.
BayCare and United have had contract agreements since 1999.
“Despite our attempts to negotiate, BayCare’s demands have remained unchanged since Oct. 11,” United Healthcare officials said in a statement. “We are hopeful, however, that they will reconsider their position. United Healthcare stands ready to negotiate terms of a new agreement that are fair, reasonable and based upon the provision of quality care to our customers.”
BayCare representatives would not comment on the negotiations.
“We cannot get into the specifics of our negotiations, because of a confidentiality agreement, but we can say that we expect fair treatment and payment for the care we provide,” BayCare System Communication Manager Dena Brannen said. “Further, we do not condone involving the community as part of a negotiation strategy.”
Under emergency medical conditions, United customers still can access care at BayCare hospitals’ emergency departments, and United customers who have out-of-network benefits or qualify for a continuity-of-care provision can continue to access BayCare facilities and physicians for non-emergency services.
Continuity of care applies to newly enrolled customers who were receiving a particular service before having United.
“If you are currently under a course of treatment, as of Nov. 26, BayCare will continue to provide care to you for the longer of the period required under continuing-care obligations previously agreed upon between United Healthcare and BayCare in our agreement or the timeframe required under applicable law,” BayCare officials said in a prepared statement.
BayCare sent 127,748 letters to patients with those plans who have been treated in the past year at a BayCare facility.
“We’re still hoping it’s going to be resolved,” said Nancy Hamilton, who works in pediatrician Dr. John Aime’s Plant City office. “We’ve had several situations like this happen before, but they always come to their senses and strike a deal.”
A similar situation occurred in 2002 between BayCare and Blue Cross and Blue Shield. The companies took three months to reach an agreement.
Without a contract agreement, local doctors will not be able to refer United patients to South Florida Baptist Hospital.
“That would cut down on new patients coming to South Florida,” Hamilton said.
Surrounding hospitals that accept United include Brandon Regional Hospital and Lakeland Regional Medical Center.
Contact Amber Jurgensen at firstname.lastname@example.org.