By Carol Gentry and Sarah Pusateri
11/27/12 © Health News Florida
Carol White of St. Petersburg and some of her friends spent Monday looking for a new Medicare Advantage plan after BayCare Health System ended its contracts with UnitedHealthcare.
She ended up going with Florida Blue, but she's plenty steamed over being forced to switch insurers to keep her doctor.
"They have caught senior citizens in the middle," White said. "It's almost unconscionable they could not work this out."
It's not only seniors who got squeezed at midnight Monday when the contract ended between one of the nation's largest health insurers and BayCare, Tampa Bay's dominant non-profit hospital chain. The break-up also affects Medicaid and employer-sponsored coverage -- a total of 400,000 United customers, said Elizabeth Calzadilla-Fiallo, spokeswoman for the Florida division of the Minnesota-based insurer.
Medicare patients are in open-enrollment until Dec. 7, so those who want to switch to a different health or drug plan still have time to do so. BayCare, in letters and newspaper ads, has been inviting them to make the switch.
It accused United -- one of the nation's wealthiest corporations -- of failing to pay bills worth $11 million. United says that it has paid all legitimate bills.
Meanwhile, United has taken the unusual step of making some of the contract numbers public to back up its argument that BayCare is being greedy. A United release said BayCare:
--Already charges more than comparable facilities in Tampa Bay for hospital treatment, testing, labs, and so on, yet wants United's $330 million in spending to go up by more than $50 million by the end of next year.
--Wants a series of rate increases on employer-sponsored plans over the coming year that would add up to 22 percent, even though United just increased its rates in June.
--Seeks payment of 8 percent above the Medicare rate for United's Medicare Advantage customers, and 5.5 percent more than the Medicaid rate for United's Medicaid members.
The rate increases BayCare seeks would add $12,000 to the cost of hip replacement and $5,500 for breast biopsy, United said. Cardiac catheterizations would cost $4,000 to $5,000 more, the insurer said.
BayCare said the numbers United released were wrong, but wouldn't say what the right numbers were. Spokeswoman Amy Lovett Dunn said United violated the contract's confidentiality clause by discussing these matters.
It's about time to let some sunshine in, says health-care consultant Brian Klepper of Atlantic Beach. He said "transparency" in pricing is the only way to build a competitive market.
Organizations that group together to flex muscles and set prices "hold the whole market hostage," said Klepper, managing partner of Healthcare Performance Inc. "This is why health care costs so much. It's pulling the rest of the U.S. economy off the cliff."
Both United and BayCare hold a substantial share of the lucrative Tampa Bay market, although not a majority. Dunn from BayCare said its market share is 37 percent; United's spokeswoman said its share is about 33 percent.
Patients and payers are caught in the middle. Those who use a BayCare hospital -- and their numbers are legion, since BayCare's Morton Plant and St. Joseph's are the largest hospitals in Pinellas and Hillsborough -- may also have a family doctor or favorite specialist who practices only at BayCare hospitals.
It is still possible that the two parties can reach agreement, but if that doesn't happen soon United customers will be squeezed, as open-enrollment in Medicare and employer-sponsored contracts nears an end. In many cases, the commercial sign-ups are already a done deal.
BayCare has 10 acute-care hospitals: Mease Countryside, Mease Dunedin, Morton Plant, Morton Plant North Bay, St. Anthony's, St. Joseph's, St. Joseph's North, St. Joseph's Children's, St. Joseph's Women's, South Florida Baptist.
The network also has a rehabilitation hospital, BayCare Alliant, which is on the Mease Dunedin campus, according to the BayCare web site.
The system last year had more than 124,000 inpatient discharges and over 435,000 emergency room visits, the web site says.
United released a list of hospitals with which it still has contracts in the tri-county area:
In Hillsborough County: Brandon Regional, Florida Hospital Carrollwood and Florida Hospital Tampa, H. Lee Moffitt Cancer Center, Memorial Hospital of Tampa, South Bay Hospital, Tampa General and Town and Country Hospital.
In Pasco County: Medical Center of Trinity, Pasco Regional Medical Center, Florida Hospital Zephyrhills, Regionnal Medical Center Bayonet Point.
In Pinellas County: All Children's Hospital, Bayfront Medical Center, Edward White Hospital, Florida Hospital North Pinellas, Largo Medical Center, Largo Medical Center-Indian Rocks, Northside Hospital and Heart Institute, Palms of Pasadena Hospital and St. Petersburg General Hospital.
Both companies released statements late today in which they said they were open to further discussions.
BayCare's statement said its employed physician groups will no longer take United's working-age and Medicaid patients, but will still see Medicare Advantage patients. BayCare’s employed physician groups include: HealthPoint Medical Group, Morton Plant Mease Primary Care, Morton Plant Mease Specialists, Morton Plant Mease Immediate Care, St. Anthony’s Primary Care, St. Anthony’s Specialists and Suncoast Medical Clinic.
United's statement said in part that the company was "disappointed that BayCare was unwilling to change its requested rate increase, and as a result they have terminated their contract with UnitedHealthcare. "
BayCare noted patients can continue to use its hospitals and physicians if they have out-of-network benefits, but should call United first to get authorization. The phone number to call is on the United membership cards.
--Health News Florida, journalism for a healthy state, is a service of WUSF Public Media. Question? Comment? Contact Editor Carol Gentry at 813-974-8629 (desk) or 727-410-3266 (cell) or write to her at email@example.com.