UPDATE 9-8-2019: When this article first published, it mistakenly used the NCQA Ratings chart from 2016-17. It has been corrected to be the latest offered by NCQA (2018-19).
Contrary to what some said, the standoff between Boca Regional Hospital and United Healthcare did not “blow over”. It’s in its third month. If you’d like to share how it’s affected you, let us know on our website and we’ll add it to our case studies to publish in our next newsletter.
According to the United Healthcare (UHC) representative I spoke to on August 19th, IBM did not renew its contract with UHC for 2020. Good for them.
I also learned one of my physicians dropped UHC for themselves and their employees. Looks like it’s a thing. Shocker. Ask around. I did. What I heard from doctors and BocaFirst readers was UHC pays less for services than other healthcare plans. Who wants medical care from someone who isn’t being paid enough? I don’t and according to the NCQA ratings, many Floridians are dissatisfied with UHC.
Boom! There Goes United Healthcare
I decided UHC was hazardous to my health. That meant switching health plans. I called UHC. But, according to the representative, there were no plans offered in the IBM contract that included Boca Regional. None. Zero. Zip. The big donut. BUT, when asked about next year, she put me on hold and then BOOM! According to the information she had, IBM did not renew its contract with UHC for 2020.
It Affects All of Boca.
The effect of United Healthcare and Baptist Health failing to close a contract in the 7 months it spent working on the merger with Boca Regional affects all of Boca. Anyone over 50 understands the need and value of a network of local medical professionals and services associated with a hospital. There’s many visits and tests. Being local matters. What used to be a ten minute trip across town is now 30 or more each way on the main arteries adding congestion to already crowded roads.
Boca has a thriving medical community built around Boca Regional Hospital. But because of the Baptist Health and UHC standoff, the healthcare dollars from Boca’s UHC subscribers is being siphoned out of Boca to Delray and Deerfield. According to a BocaFirst reader, Boca Regional won’t even take cash for out-patient services. The hospital services are also losing healthcare dollars. Your Boca doctor’s medical practice is losing income. Expect cost savings cuts.
Kudos to IBM.
If the UHC representative was right and IBM did not renew its contract with UHC, perhaps it’s because IBM has seen this movie before. A quick search finds similar situations where UHC failed to pay hospitals enough in New York, Alabama, Iowa, Arkansas and Austin, Texas (another IBM stronghold). In Austin, UHC dropped the entire 10 location network of Austin Regional Clinics in 2018. It’s still out of network almost a year later.
Hope Springs Eternal.
IBM retiree’s and employees in Boca are not out of the woods. Maybe the UHC contract will be renewed. Maybe the new plan provider won’t have Boca Regional in its network. Mid-October is when healthcare plans are revealed and we’ll find out if it includes Boca Regional. Word on the street is that Baptist Health renegotiates all its contracts at the same time of year: October. Hopefully the Baptist Health – United Healthcare standoff will be resolved. For now.
That would be a great relief to a great many people; especially those who have no options. But who wants a healthcare plan that underpays and has a chronic problem with Boca Regional? Some BocaFirst readers are spending everyday handling their medical needs, fighting for life. Still others are considering moving out of Boca. I’m looking at alternative plans so I’m ready come enrollment season. Your mileage may vary.
Filing a Complaint with the State
In my previous article When People Become Pawns, I documented that the State of Florida Consumer Services Department was the regulating agency for Health Insurance. So I filed a complaint.
After a couple days, an investigator called. In my case, my IBM healthcare plan was a “self insured” plan. That means IBM, sets aside their own cash to pay your bills. They hire an insurance company like United Healthcare Services to do the paperwork and provide a network of doctors and facilities. UHC manages who is in the network and who is not. The bad news is that the State of Florida has no jurisdiction over self insured plans.
The good news is that if your UHC plan isn’t self insured, you may be able to file a complaint. By law, UHC has to respond to every complaint within 20 days.
Filing a Complaint with the U.S. Department of Labor
While the State of Florida has no jurisdiction over self insured plans, the federal government* does. The Employee Retirement Income Security Act (ERISA) of 1974 sets rules for private employer-sponsored benefits or union plans, including health insurance. Filing a complaint was straight forward. The essence of my complaint was that it was a bait and switch.
Within 48 hours of filing a complaint with the U. S. Department of Labor, I found myself explaining the situation to a very interested investigator. Unfortunately, with self insured plans, the contract is between the employer and the healthcare plan provider. As a subscriber in the IBM Retiree group plan, I have no standing. Furthermore, there’s no law that prevents a healthcare plan from changing its network of doctors and hospitals midway through the year. But, you CAN switch to a new healthcare plan.
* U.S. Department of Labor, 200 Constitution Avenue, NW Washington, DC 20210-0001, Toll-free: (866) -4-USA-DOL, (866) 487-2365, Email: https://www.DOL.gov/general/contact/contact-email, Website: www.DOL.gov