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the human cost of UHC impasse

The Human Cost of Boca Regional vs UHC

by Les Wilson

This article looks at the real world human cost of Boca Regional Hospital being dropped by United Healthcare employer and AARP Medicare Advantage plans … as told by those affected.

Boca Regional was an independent Hospital. It’s now part of the Baptist Health South Florida organization. If you have followed the hospital’s evolution, you probably hope, as I do, that the incoming Baptist Health executives will clean house and reestablish contracts, relationships and services that reflect the needs of our community. If you haven’t followed things at the hospital, it stopped being a community hospital and evolved into a regional one closing its pediatric care along the way and is without a dedicated geriatrics department. From my research, Baptist Health is probably the best thing that’s happened to Boca Regional Hospital in a decade.

All you have to do is divorce your cancer stricken spouse.

ICYMI, Boca Regional was dropped as an In-Network facility for the affected United Healthcare (UHC) plans on July 1 2019 when its contract with UHC lapsed. We estimate 20% of the population is affected. Since then, IBM and other employers have dropped UHC or plan to starting January 1 2020. Employees in companies that stay with UHC are stuck. But UHC Medicare Advantage Supplement customers can change in the upcoming enrollment period. Otherwise if you want to keep your medical network based on Boca Regional, there’s few options other than to leave the employer group and purchase your own insurance. If you haven’t voiced your dissatisfaction with your employer, UHC, Boca Regional or (for non-self insured employers) the State, then your voice has not been heard. See the addendum in our previous article IBM drops UHC for more about filing a complaint with the state.

Boca Regional Response

We asked Boca Regional about the prospects for closing a deal by the time enrollment comes around in October and they said:

Baptist Health and Boca Raton Regional Hospital would like to assure the community that we continue to actively work with UnitedHealthcare to come to an agreement. It is a high priority for all parties to have Boca Raton Regional Hospital back in UnitedHealthcare’s network as soon as possible. We will continue to provide updates to the community as they become available.

Boca Raton Regional Hospital

Donors to Boca Regional should be livid about the human cost of the lapse

The hospital “Chairman’s Circle” donors give $100,000 or more per year to the hospital. There’s 50 of them. They should be up in arms that the hospital has to turn away 20% of Boca’s residents. Donors to Boca Regional are philanthropists. They care about people. Their hearts should be broken by the human cost of the failure to to reach a deal.

If you like your doctor, you CAN’T keep your doctor.

Meanwhile, Boca residents pay the price. Furthermore, while local media and local blogs turned a deaf ear to the human cost, we have not. In our previous article, we solicited the real world experiences of BocaFirst readers dealing with Boca Regional being dropped from their UHC coverage. Below are six responses we selected that illustrate the various facets of how the contract impasse has affected them and their families. They are your friends and neighbors. These are their stories:

All you have to do is divorce your cancer stricken spouse

My husband was diagnosed with cancer in June. The work up went quickly as I am a physician but threatened to come to a screeching halt when the first chemo was to begin July 2nd at Lynn cancer center at Boca Regional. Anyone who has or cares for someone with cancer knows the absolute emotional anguish that ensues and in short order. You can understand the sleepless nights, endless phone calls and extreme emotional turmoil that complicated our lives. Not to mention the new financial burden.

We now have in-patient and out-patient copays and in-network and out of network copays. I can get him on another insurance outside of open enrollment if I divorce him. Seriously. Not funny. This is our lives UHC is dealing with. They need to be stopped! My own practice is fed up with the egregious practices of UHC … delay tactics, prior authorizations, step edits, bait and switch and other unscrupulous behaviors. We are the working class of America. We don’t use our insurance much, thankfully, but when we do … this happens. If you are under 50, you probably have no idea what trash looms ahead. On your next open enrollment DON’T choose United Health Care. Nothing UNITED about them!!

If you like your Doctor, you CAN’T keep your Doctor

First I had to change my hematologist because he only works at Boca Regional. Now, in September, I received a letter that says that starting October, my gynecologist will no longer be taking UHC. This is a doctor that I’ve been with for 15 years. When our renewal comes up in December we’ll be looking for a new insurance company. I don’t blame the doctors and hospital for not renewing if they aren’t getting paid enough, but in the same vein, insurance is so expensive, it’s hard to find an affordable option. Something’s got to change somewhere.

As if cancer patients don’t suffer enough

Thank you BocaFirst for giving us all a voice. I am insured through United Healthcare at work. My company is not based in Florida. I am 46 and had breast cancer 18 months ago. My treatment included testing, imaging, surgery and radiation. Through all that, I developed a strong relationship with my practitioners at the wonderful LYNN Cancer institute, by whom I can no longer be treated. Many of them came recommended to me by a close friend or doctor; including my oncologist, radiation oncologist and surgeon. I was very upset when I found out I had to change my ENTIRE cancer team due to the disagreement over insurance payments between two lucrative entities (UHC and BRRH).

This all happened on the same, very stressful, last week of June that I felt a NEW lump in my breast. Can you can imagine my panic? Thankfully, I had an appointment coming up and they squeezed me in before the July 2nd deadline. Everything checked out ok. But all my standard follow-up appointments were CANCELLED. I was on my own to find a whole new TEAM of doctors in a different city. My family and I are now finding new providers that are In-Network for UHC but also have privileges at an In-Network hospital elsewhere. It changes our whole plan of care for ongoing health issues. It also means more time away from work for farther drives for appointments/care, farther drives for Emergency care … not to mention terminating of all the trusting relationships we have developed with our practitioners through the years.

I started by calling UHC and Boca Regional but got the same info that you did “We’re working on it.”.

I can’t even pay cash at Boca Regional

I’ve been in pain since 2012 due to scar tissue from pelvic prolapse surgery. Recently I was examined by a physician at Boca Raton Regional Hospital’s Lynn Woman’s Health and Wellness Institute, who wrote a prescription for an MRI of the pelvic area. When I went to make an appointment at Boca Ration Regional Hospital’s Imaging Center, I was told that they are no longer in the United HealthCare network and no longer accept United Healthcare Medicare Advantage patients.

I offered to pay out-of-network fees, but they declined to accept that and would not make an appointment for me. I then offered to pay cash, but was still rejected. The physician who wrote the prescription at Lynn Woman’s Health and Wellness Institute was shocked. Our family has lived in Boca Raton for 27 years and have been using the services of Boca Raton Regional Hospital for that long. I’m very disappointed that the two parties have decided to ignore the problems their dispute has caused for their patients and members.

Healthcare dollars leaving Boca

Last month, my sister had a cardiac problem that required three days of care at Delray Medical Center because she has United Healthcare Insurance. All those medical care dollars went to Delray hospitals and doctors instead of Boca Regional, local doctors and labs. She had to go back in this week. Can you hear the sound of all that money being sucked out of Boca’s medical economy?

The United Healthcare Gap Provision is a myth

Those who poo-poo this contract dispute as a temporary inconvenience disgust me. Three months into it, I am still having a bear of a time finding alternative care. UHC says they provide a GAP provision for people in the midst of treatment. I have tried on appeal to get the GAP provision for a critical test done weekly at BRRH. Even with my doctor writing a letter and other medical expert testimonies they denied me twice on appeals.

I just came back from having to go to a new doctor in Coral Springs to have a procedure ironically done at a Baptist facility that could have been done at BRRH if they still took UHC. It couldn’t even be done in Delray because they don’t offer it there from the same group, and the doctor I was going to does it at BRRH, but not his practice in Delray at the hospital. Additionally, it’s the same group in Coral Springs that I had to go to because not all offices offer this procedure. It is so frustrating!

The problem is widespread. The solution must be local.

Underpayment of medical providers is a commonly reported complaint about United Healthcare. More about that in a future article. UHC has over 40 million subscribers. Do you think they care if 17,500 Boca subscribers leave them? Practically speaking, it’s up to Boca Regional management to solve the problem. It is hard but it is important.

It’s up to Boca Regional management to solve the problem.

The contract issue with UHC has been chronic for many years. But for 2019, the pre-merger leadership apparently decided it was unable to afford to take the largest health insurance provider in the country. Let that sink in. Unlike other hospitals in the area and others in the Baptist Health South Florida network, they decided they cannot take UHC patients. Are they better off financially to turn away 20% of its customer base than to treat them for what UHC will pay? That is the bitter pill Baptist Health has to swallow. How did it come to this?

Bottom Line

Who wants healthcare from someone who isn’t paid enough by your health insurance?

To be honest, until there are wholesale cancellations by employers that shed UHC as IBM did, the local problem will not be solved by the UHC part of the equation. Apparently, UHC refuses to pay enough and some hospitals can’t survive if they take patients with UHC. But other hospitals 30 minutes drive north and south of Boca Raton are able to do it. The short term solution to this problem is going to have to come from Boca Regional. If they do, they should be applauded. If they don’t, Boca’s medical community will suffer the economic drain and it’s a black eye for all of Boca; especially to anyone looking to move here to live, work, learn and play.

In the long term Boca Raton residents who are able, can team up with insurance policies that pay the freight. But employees (and their families) of companies with healthcare plans that don’t include Boca Regional are stuck. Who wants healthcare from someone who isn’t paid enough by your health insurance?

BRRH Statement
BRRH Statement online

For more information:

This is the 6th article in our series on the impasse between United Healthcare and Boca Raton Regional Hospital. Previous articles:
1) Boca Raton Regional Hospital Fails its Strategic Vision When United Healthcare Drops it.
2) Baptist Health South Florida Heard You
3) Get the 411 on UHC at Boca Regional Before You Dial 911
4) When People Become Pawns
5) IBM Drops United Healthcare For 2020

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