United Healthcare Blocks Medicare Patients from in-network rates with UC Health

Cincinnati, OH—January 1, 2015 — UC Health is disappointed to announce that UnitedHealthcare has refused to finalize an agreement before the December 31, 2014 midnight deadline which would allow its Medicare Advantage members to continue to receive care from UC Health physicians and facilities. Effective today, all UnitedHealthcare Medicare Advantage members who use UC Health physicians and facilities for their high level specialized care will be considered out of network through the provider. As a result, these patients will be subject to higher costs when seeing a UC Health physician or receiving care at a UC Health facility.

A resolution has been reached between UC Health and UnitedHealthcare allowing UnitedHealthcare commercial insurance plan participants only to access UC Health services and facilities at “in-network” rates.

“My team and I are concerned first and foremost about our patients. Our doctors, nurses and the entire UC Health care team are committed to doing all that we can to ensure that our patients continue to receive the continuity and quality of care they need in the safest possible manner,” Said Richard Lofgren, MD, UC Health President and CEO. “I want to ensure every UC Health patient who is currently a UnitedHealthcare Medicare Advantage plan participant that we will continue to do everything that we can to resolve this situation. We will continue to negotiate with United Healthcare representatives round the clock if necessary, including over this holiday weekend.”

UC Health has worked diligently for many months to avoid any interruptions of care for all our UnitedHealthcare participants. Unfortunately UnitedHealthcare is choosing to reduce the number of their higher cost patients within its Medicare network by denying UC Health physicians and facilities from their Medicare Advantage network.

UC Health spokesperson Diana Lara stated, “After months of discussions, we are shocked by UnitedHealthcare’s actions. Effectively removing the nearly 800 specialists and primary care physicians of University of Cincinnati Physicians and the UC Health facilities (University of Cincinnati Medical Center, West Chester Hospital, Daniel Drake Center) from their Medicare members effective January 1st, 2015, and disrupting patient-physician relationships is unconscionable. This will force thousands of patients to make changes in a rushed and stressful way.”

As Greater Cincinnati is aware, UC Health is the region’s only academic medical center, providing essential advanced specialty services to the sickest of the sick in their critical time of need. We believe that this is UnitedHealthcare’s nation-wide Medicare strategy to exclude academic health centers out of their own network along with their sickest and most costly members.

Lofgren added, “As a physician I recognize this is alarming and potentially disruptive to our patients. We continue to ask UHC to reconsider on behalf of our patients. UHC Medicare members, such as cancer patients, should not endure the added stress and worry of being forced to switch doctors in the middle of their treatment.”

***A Patient letter was sent to United Healthcare Medicare Advantage members who use UC Physicians or any UC Health facility included the following below:

What should UC Health patients with UHC’s Medicare Advantage do about their care?

  • Call your UC Health physician’s office if you have a medical concern or health care need.
  • Recognize that you will be granted access to care within the emergency departments of University of Cincinnati Medical Center or West Chester Hospital regardless of the outcome of this negotiation process.

What can patients enrolled in the UnitedHealthCare Medicare Advantage Plan do to effect change?

1. Call UnitedHealthcare to urge them to continue negotiations with UC Health. Specifically,Kurt Lewis
Executive Director, UnitedHealthcare of Southwest Ohio
9050 Centre Pointe Drive
West Chester, Ohio 45069
(513) 603-6880

2. Switch Medicare plans:

Patients who wish to return to their traditional Medicare plans and to continue their care with UC Health physicians and facilities have between January 1, 2015 and February 14, 2015 to make a change. During this time, patients may call Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov and click the tab: sign up/change plans to effect the change.

3. Call your congressman to alert them:

Nationally, health care insurance companies’ strategy is to exclude Academic Medical Centers from the Medicare plans therefore shifting high cost Medicare patients from their networks to other networks. United Healthcare is adopting this strategy to shift the sickest and most costly patients in an effort to boost their profits..

*** In summary, if your medical plan benefits are provided to you by a UnitedHealthcare commercial product, you will be able to access the UC Health system and will receive care at “in-network” rates. If your medical plan benefits are provided to you by the UnitedHealthcare Medicare Advantage product, you may be subject to “out-of-network” fees when accessing the UC Health system. As stated above, we will continue to work to the best of our abilities to help ensure that UnitedHealthcare Medicare Advantage plan members are offered access to our system utilizing “in-network” rates. Should you have any questions regarding any of the content contained within this letter, please contact the UC Health Customer Service Department at 513-585-8050.

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