By Nichole Aksamit, Omaha World-Herald, Neb. Knight Ridder/Tribune Business News
Sep. 29--Children's Hospital is warning some families that they may have to pick up more of the bill for care at the hospital, its emergency room and urgent-care centers -- including treatments they have received since Sept. 13 -- pending the outcome of a dispute with an insurance company.
The Omaha hospital sent a letter to recent patients who have coverage from United HealthCare Inc.
The letter said the hospital and the insurer have entered binding arbitration to resolve a dispute over how United HealthCare reimburses the hospital for pediatric patient services.
'It is possible that United will consider Children's to be an out-of-network provider after September 13, 2003,' the letter warned. 'The result could be additional out-of-pocket costs, which would be your personal responsibility.'
A statement issued by United HealthCare Chief Executive Kathleen A. Mallatt said that Children's is unnecessarily alarming patients and putting them in the middle of a dispute about money. She indicated that the outcome would not affect patients' bottom line.
'Customers should continue to use Children's as they always have,' the statement said. '. . . We commit to holding our customers harmless, so that their financial responsibility for services at Children's will remain the same, regardless of the arbitrator's decision.'
United HealthCare spokesman Mike Strand said the company also is negotiating with other Omaha hospitals, including the Alegent Health System and the Nebraska Medical Center, and intends to reach agreements with them and with Children's.
But leaders at other health systems are also upset with the pace of negotiations with United HealthCare.
Great Plains Regional Medical Center in North Platte has been unable to reach a contract agreement with the insurance company. Some people in the area, including some dependents of Union Pacific Railroad employees, are paying out-of-network rates.
The chief executive officer at Great Plains Medical Center, Cindy Bradley, said the hospital and United HealthCare have tried but have not come to terms on the financial aspects of a contract.
Strand said the insurance company has a contract with Ogallala Community Hospital, about 50 miles away, that will start Wednesday, and is working toward a contract with doctors there.
'We know it's a gap, and we're working diligently to obtain a contract' with the North Platte hospital, he said.
In Omaha, Methodist Hospital and a couple hundred Methodist-affiliated doctors recently sent notice that they won't be a part of the insurance company's network at the end of this year.
That means that people with United HealthCare insurance may have to pay out-of-network charges for Methodist health services, starting next year. That is a significant development, when considering that many of Omaha's largest employers offer a United HealthCare plan.
Last-minute negotiations could get Methodist and its doctors back in the insurance network without disruption to patients, said Ken Klaasmeyer, president of Methodist Health Partners, an organization that aids the Methodist hospital and doctors in their negotiations over insurance contracts.
But he is not optimistic. United HealthCare hasn't provided them with a proposed list of rates it will pay for health-care services under a new contract. Methodist expected such a proposal months ago, Klaasmeyer said.
'From our standpoint, United has not negotiated like they need us in the network or want us in the network,' he said.
Strand, the United HealthCare spokesman, said, 'Of course we want Methodist and its physicians in the network. And we intend to continue to negotiate in good faith to ensure that happens.
'But it's also a two-way street. That's why we bargain, to come to an agreement, not to capitulate to demands.'
He declined to comment on the list of proposed rates.
'It's a bargaining process, and we are sad to see these things being played out in the public, which only raises everyone's concerns unnecessarily,' he said.
Children's spokeswoman Laura Gell said Thursday that the hospital continues to file insurance claims with United HealthCare and conduct other business as usual, as if the relationship were unchanged.
'But,' she said, 'we felt it was our ethical obligation to tell our patients that we were entering into arbitration, rather than telling them afterward when there may be a change.'
In addition to the reimbursement issues, it appears the hospital and United HealthCare disagree on the expiration date of the contract between them.
Gell said the terms of the three-year contract expired on April 30, 2003. When efforts to agree to new terms failed, she said, the hospital notified United HealthCare in August of its intention to end the contract Sept. 13. Instead, she said, both sides agreed to enter arbitration and let a third party decide the matter.
United HealthCare's statement said the contract is valid until at least April 30, 2004, and that it would notify customers directly and in a timely fashion of any changes to its provider network.
It isn't known how long arbitration will take.
Children's has contracted with United HealthCare since 1991. Those insured with United HealthCare have seen double-digit increases in their premiums in recent years.
Karla Macdissi, a sales executive for the Grace-Mayer Insurance brokerage in Omaha, said she has told her business clients that customers will not have to pay extra medical costs and that they would receive proper notice if there were any changes in the insurance company's network of health-care providers.
'If it can't be worked out, we all lose,' Macdissi said.
World-Herald staff writers Jeremy Olson and Steve Jordon contributed to this report, which also includes material from The Associated Press.
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(c) 2003, Omaha World-Herald, Neb. Distributed by Knight Ridder/Tribune Business News.
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