UPDATE: CHI Memorial, UnitedHealthcare reaches new agreement
CHI Memorial Health Care System and UnitedHealthcare announced Monday they reached a new agreement for commercial health plans.
UPDATE: CHI Memorial Health Care System and UnitedHealthcare announced Monday they reached a new agreement for commercial health plans.
The new contract gives UnitedHealthcare employer-sponsored and individual members in-network access to care at CHI Memorial Hospital, CHI Memorial Hospital Hixson, CHI Memorial Ooltewah Imaging Center, CHI Memorial Medical Group physicians, The Chattanooga Heart Institute physicians, EMS, CHI Memorial Health at Home, the Rees Skillern Cancer Institute, and the MaryEllen Locher Breast Center.
“While these negotiations extended beyond our contract, they were also very important to our organizations. This new agreement sets the stage for a cooperative relationship that allows both parties to explore ways to incorporate new models of care in the future. We feel the new contract reimburses CHI Memorial fairly for the services we provide to UnitedHealthcare members and recognizes the value CHI Memorial brings to people in Southeast Tennessee. We look forward to continuing our relationship with UnitedHealthcare,” said Larry Schumacher, CEO of CHI Memorial and Senior VP of Operations, Southeast division.
The agreement is effective immediately and retroactive to November 1, 2016. CHI Memorial’s participation in UnitedHealthcare’s Medicare Advantage network for its hospitals will only extend through Dec. 31, 2016.
PREVIOUS STORY: More than 5,000 people insured by a major health insurance company are no longer covered at a local hospital. The contract between UnitedHealthcare and CHI Memorial expired at midnight.
Hospital officials said admitted patients are covered on Monday until they're released, but it gets complicated for people who have appointments scheduled after Monday or have ongoing treatments.
"People who have terminal illnesses should not have to jump through hoops to get their medicines covered and to continue care with their doctors," Scottie Summerlin, the wife of a cancer patient said.
Summerlin has enough stress as it is since her husband has Stage 4 Secondary Bone Cancer.
She learned his health insurance coverage through United is in jeopardy if he wants to continue seeing his doctors at CHI Memorial.
They have some options like applying for what's called "continuity of care", but that would only be good for a few months, if approved.
"He sees at least 10 doctors for a variety of services for having a terminal diagnosis and so I have to fill out 10 pieces of paperwork that's not even guaranteed," Summerlin said.
CHI Memorial and UnitedHealthcare have been in negotiations for months. The two have had a partnership for more than 15 years, but each is blaming the other for the contract expiring.
"Even if we chose to pay out of network coverage, it would cost us thousands of dollars. We've already paid thousands of dollars through our regular health care coverage. It's absolutely ridiculous," Deseret Ward, another wife of a cancer patient said.
Ward whose husband has Stage 4 Colon Cancer is also anxious about the standoff.
UnitedHealthcare issued the following statement:
“We offered a new contract that would increase how much CHI is paid every year, but they refused and are insisting on raising costs at their hospitals by nearly 20 percent over three years. We are committed to continuing the negotiations and are hopeful an agreement can be reached as quickly as possible to restore our members’ access to CHI Memorial," Tracey Lempner, a spokeswoman from UnitedHealthcare said.
In response, CHI Memorial released the following statement about the status of the contract negotiations:
"CHI Memorial has been in negotiations with UnitedHealthcare on a new contract for care provided to its members for several months. The current contract expired on October 31, 2016. While CHI Memorial leadership worked hard to resolve this contract prior to its expiration, we have not yet agreed to favorable terms.
As a result, CHI Memorial Health Care System facilities including CHI Memorial Hospital, CHI Memorial Hospital Hixson, and CHI Memorial Ooltewah Imaging, as well as CHI Memorial Medical Group physicians and The Chattanooga Heart Institute physicians, are considered out-of-network starting November 1, 2016 for UHC members with all Commercial Group and Individual plans, HealthCare Exchange plans, and AARP Medicare Complete Plans.
Our inability to finalize a contract by the expiration date is a direct result of UnitedHealthcare’s failure to accurately and fairly reimburse CHI Memorial for services and care provided to UnitedHealthcare members. CHI Memorial asked for a single digit increase that will provide for a standard annual rate increase and correct an issue with our contract. Our prior contract failed to reimburse us, or reimbursed us below cost for key outpatient services.
Recent analysis shows that CHI Memorial is the high quality, high value health system in Chattanooga, yet our reimbursement from UnitedHealthcare is not in parity with other payers in the market. What’s more, our physician reimbursement is below market. We find ourselves unable to continue to function in this manner, and have requested that they work with us to restore our reimbursement to fair market rates.
We are committed to continuing to meet and discuss with the UHC team again and hope these negotiations are resolved. We will continue to keep our community updated as negotiations progress."
Most Medicare patients won't be affected. Anyone with an emergency would also still receive in-network care at Memorial.
Anyone who is insured by United and has questions is asked to call the number on their health insurance card.
Stay with WRCBtv.com for updates on this developing story.
PREVIOUS STORY: Thousands may have to find a new doctor if an agreement isn't reached between a local hospital and a major health insurance carrier.
CHI Memorial and UnitedHealthcare started negotiating weeks ago, but it appears they're at an impasse.
If the hospital and health insurance company can't come to a compromise by the end of the month, more than 5,000 people would be affected. It could also mean people insured by United would have to pay more for their care.
The standstill isn't sitting well with some local families.
Five months ago, Scottie Summerlin's husband was playing softball with a church group when he broke his arm. The next day, he was diagnosed with stage 4 secondary bone cancer.
Now, the Summerlin family is dealing with a new obstacle.
"Our oncologist is our quarterback and we cannot lose our quarterback in what is a very dire situation," Scottie Summerlin who is the wife of a cancer patient said.
She found out her family's health insurance provider and CHI Memorial, where her husband receives care, are at a standstill. If they can't reach a deal, the hospital would be considered an out of network provider beginning November 1.
"Why should we have to have more stress and more costs and more anxiety on what's probably the worst situation that you could come to in life, possibly losing your spouse and the father of your children over a technicality?," Summerlin said.
The hospital's CEO sent a letter to all doctors affiliated with CHI Memorial telling them about the impasse.
Here's a copy of that letter:
In response, Tracey Lempner, a spokeswoman for the health insurance carrier, issued the following statement:
“CHI Memorial wants to raise the cost of care at its hospitals by 13 percent in just one year, which is nearly four times more than the average annual increase in health care costs. The hospital system also wants an additional 10 percent increase over the next three years. This increase is simply not sustainable for local employers or consumers. Despite CHI's recent claims, UnitedHealthcare’s latest offer does include rate increases that are competitive and consistent with what other local providers are paid for the same services."
"My heart sank because i don't know what exactly we are expected to do because when you have a life threatening illness, it's not like you can switch doctors all of a sudden," Deseret Ward who is also the wife of a cancer patient said.
Deseret Ward's husband has the same oncologist as Summerlin's. Her husband has stage 4 colon cancer.
Both of these women said they're ready in case a deal can't be reached.
"Fight the insurance company. The insurance company is supposed to be on team Dan and we need our doctor at memorial hospital. He manages all of her care and we are not going to take this lying down," Summerlin said.
UnitedHealthcare also sent a letter to those they insure to inform them of the standstill.
They listed other hospitals that are covered in case they can't come to a compromise by the end of the month, but the families Channel 3 spoke with said that's not an option for them.
Stay with WRCBtv.com for updates to this story.