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Georgia Hospital Contract with United HealthGroup Confusion–Letter Said Yes and CEO Said No–Negotiation Continues

Posted Jul 31 2010 1:15pm

There seems to be a number of these contract negotiation stories hitting the news today as contract become more cumbersome with making sure all the costs are covered.  In Florida there are ongoing issues as well.  image

In Orange County it gets a bit stickier as perhaps the hospitals have contracts but the employer contracts for insurer benefits are not honored at the hospital.  I am guessing the rates would be less than the over all contract with the hospital.

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

According to the article doctors were sent letters in error stating that an agreement had been reached, but the hospital CEO said no, not yet.  Some of the algorithmic formulas used today by insurers are so complex too that even peer groups and boards are trying to figure out how they apply too. The link below from a hospitalists talking about his experience is a good example. 

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

As the costing algorithms ran by health insurance companies continue to grow more complex in wording and nature, so grows the inability to communicate and collaborate as shown here.  How do healthcare institutions continue to work within the realms when they become so complex to understand?  I said a couple years ago that we need to certify some of their formulas just like we do with medical records so all can be assured of what financial transactions will occur when a patient needs care.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

Wendell Potter, a former CIGNA employee turned patient advocate has some words of wisdom and who should know better than one who worked on that side of the business for years.  BD

While contract negotiations between The Medical Center of Central image Georgia and United Healthcare are apparently not over, a memo was sent out to Macon area doctors this week saying an agreement had been reached.

A contract dispute between the hospital and the insurance provider developed earlier this year over reimbursement payments. The end result is that the Medical Center became an out-of-network provider for United Healthcare insurance, which would cost members more for treatment. United Healthcare is one of two providers offered to state employees.

Hospital officials say United Healthcare did not honor its contract, but the insurance company ran an ad in The Telegraph saying it is in compliance with the contract.

The insurance company offered members a PPO plan and an HMO plan, and Faulk said the hospital’s insurance office began noticing in January that all payments were coming in at the HMO rate, which was lower than the PPO rate.

Then in May, the hospital became aware United Healthcare was sending letters to doctors that they would be out of network if they used the Medical Center, Faulk said.

“United Healthcare wanted to wait until the end of the (calendar) year to fix it,” he said. “They said that their client is the state and they have budget issues.”

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