Insurance clock ticking


About 160 county employees, nearly 300 employees of the Hillsboro City School District and others insured by United Healthcare could be impacted when nearly 20 local doctors are no longer part of the commercial United Healthcare network starting Saturday.

But a spokesman for United Healthcare said Thursday the company hopes to resume discussions with the doctors and reach a resolution “that won’t significantly increase the cost of healthcare for local residents.”

Local doctors who are part of Highland District Hospital’s Professional Services Corporation will no longer be part of the United Healthcare network because they say United’s reimbursement rates have not been increased in six years.

The doctors say the rates have remained unchanged even after three years of negotiations, and that current rates are, on average, 12 percent lower than even Medicare rates as well as the rates paid by most other commercial health insurance carriers.

A flier from the doctors’ organization describing their decision to opt out of the United Healthcare network says that among the doctors no longer participating in the United network will be those with Highland Family Medicine, Highland Family Healthcare, Lynchburg Medical Center, Greenfield Medical Services, Physicians for Women, Highland Neurology, Southern Ohio Psychiatric Associates, Highland Pulmonology, Highland Gastroenterology, Highland Advanced Orthopedic and Cancer Care.

The hospital itself, including lab work and other services, will remain part of the United Healthcare network, as will emergency room doctors and outpatient specialists not listed above.

The change means that patients who have United Healthcare insurance and who see providers who are leaving the network will likely experience high family deductible obligations of as much as $4,000 before insurance reimbursements eventually kick in.

Randy Lennartz, chief financial officer for Highland District Hospital, said United Healthcare’s refusal to negotiate better rates is another example of why it’s difficult to retain doctors in Highland County.

“Doctors get very discouraged,” said Lennartz. He said it is not unreasonable to expect an insurance carrier to reimburse at least as much as Medicare.

Lennartz said Highland County is a “physician shortage area,” and over the years it became increasingly difficult to attract and retain doctors locally. So HDH eventually began employing doctors through Professional Services Corporation. The hospital helps fund the entity and provides administrative services for the doctors in an effort to maintain quality medical care here, said Lennartz.

But the doctors’ group is operated by an independent board, which made the decision to leave the United Healthcare network.

As the flier from doctors describes the situation, “After August 1, 2015, we will be ‘out-of-network’ for commercial United Healthcare. You can remain a patient of this office. However, if you continue to see providers in this office, your financial responsibility may be higher.”

Jim Smith, superintendent of Hillsboro City Schools, said that about 80 percent of the district’s 325 employees have United Healthcare coverage provided through the school. The district is part of a large consortium that negotiates healthcare coverage as a group.

Smith said he has seen similar events play out over the years, and they are usually resolved.

“It’s brinksmanship,” said Smith, noting that settlements are usually reached even after deadlines have passed. “I wouldn’t be surprised to see that happen here,” he said.

But Smith said it was an unfortunate situation for employees. “Some might be forced to switch” healthcare providers, he said. “Or, they might see the same doctor but in a different locale.”

Shane Wilkin, president of the Highland County Board of Commissioners, said commissioners wrestled with the dilemma before recently agreeing to renew its policy with United Healthcare.

Wilkin said the county had to choose between maintaining its ties with United Healthcare, which guaranteed a premium decrease, or switching to another company which would likely cost considerably more in premiums both for employees and for the county. Wilkin said the county spends $60,000 a month on insurance premiums for employees.

“I’m trying to control costs for insurance,” said Wilkin. He said most employees with whom he spoke indicated they did not want an increase in insurance premiums, even if it meant that many local doctors would be out-of-network.

The county’s health insurance broker is the Brown Raybourn agency in Ashland, Ky. In addition to United Healthcare, the agency handles policies with many insurers, including Anthem, Medical Mutual, Aetna and others.

David Brown, company president, said Thursday that he recommended to county commissioners that they stay with United Healthcare.

“We work for the commissioners,” said Brown. “It was tough for them. They took (the doctors’) concerns to heart, and we did a great deal of work on the claims history. But they have a fiduciary responsibility to their employees and the taxpayers. Our recommendation was to renew with United.”

Brown said, “We want employees to have access to every quality provider they can.” In regard to the impasse between United Healthcare and the doctors affiliated with HDH, Brown said, “We hope they come to an agreement.”

Dr. Brian Jolitz, longtime obstetrics and gynecology specialist who is returning to the HDH Professional Services Corporation after a stint with Mercy Health, said Thursday the United Healthcare issue is “very disruptive for patients.”

“It’s kind of disappointing,” he said, noting that some patients might have to travel “60 or 70 miles” to visit an in-network specialist. He said most insurers “at least match Medicare” in reimbursement rates, with many reimbursing at higher rates.

Lennartz said Thursday there had been no additional discussions or communication with United Healthcare as Saturday’s cut-off date approached.

But Tony Marusic, a spokesman for United Healthcare, said Thursday, “We hope to resume discussions with Highland District Hospital’s Professional Services Corp and remain committed to renewing their participation in our network without significantly increasing the cost of health care for local residents. United Healthcare members will continue to have access to a broad network in the area, including all hospitals across the region and more than 7,000 physicians.”

According to the flier from the doctors’ group, “The underpayment (from United Healthcare) causes financial stress to the Professional Services Corporation. If left uncontested it would jeopardize our ability to maintain quality providers in the community. Our only alternative is to terminate the agreement.”

The doctors encourage those who are impacted to contact United Healthcare on the toll-free number on the back of their insurance cards.

“We hope this encourages United Healthcare to resolve the issue prior to the August 1, 2015 deadline so that you and other valued patients can maintain your network relationship with your healthcare provider,” the flier concludes.

Reach Gary Abernathy at 937-393-3456 or on Twitter @abernathygary.

Nearly 20 local doctors will no longer be part of the United Healthcare insurance network starting Saturday because of a dispute over what doctors say are low reimbursement rates that have remained unchanged for six years. 20 local doctors will no longer be part of the United Healthcare insurance network starting Saturday because of a dispute over what doctors say are low reimbursement rates that have remained unchanged for six years.
Many HDH docs leaving United network

By Gary Abernathy

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