Gwendolyn Wu Jan.
9, 2020 Updated: Jan. 9, 2020 10:32 a.m.
Houston Methodist,
its contract ended with the United Healthcare, has launched an advertising
campaign telling patients covered by the insurer that they can still use the
hospital system’s facilities and doctors with “out of network” benefits.
But consumer
advocates say the advice, while accurate, leaves out a key point:
UnitedHealthcare patients can expect to pay more because they are no longer
getting medical services within the United Healthcare network.
“If a patient is
treated out-of-network, their out-of-pocket costs will be more,” said Stefanie
Asin, a Houston Methodist spokesperson. “But we will be clear about those costs
up front and work with individuals if necessary on the out-of-pocket amounts.”
UnitedHealthcare,
claiming that Houston Methodist’s costs were too high and out of line with
other health care providers, terminated its contract with Houston Methodist on
Dec. 31, affecting about 100,000 patients. Hospitals, clinics and other
facilities lost their in-network status when the contract expired.
Health care providers
within an insurers’ network are determined through contract negotiations, which
set prices, reimbursement rates and other conditions. Networks give providers
access to patients, insurers control over costs and patients preferred prices.
Patients using out-of-network care often are charged 2 to 3 times more than if
it is in network.
Rising health care
costs and pressures from employers to hold down those costs have led to
contentious negotiations between insurers and providers in recent months. On
Dec. 31, Houston-based Community Health Choice ended its contract with
Kelsey-Seybold Clinic. Cigna said it would terminate its contract with
Memorial Hermann in March, affecting up to 178,000 customers.
Houston Methodist ran
newspaper, radio, television and billboard ads in December as it sought to
pressure UnitedHealthcare to offer more favorable terms in the contract before
it expired, arguing that UnitedHealthcare was more interested in profits than
patients. A week after the contract between Houston Methodist and
UnitedHealthcare expired, the ad blitz continues.
“Even though
UnitedHealthcare forced us out of its network, members can still access our
facilities and doctors with out-of-network benefits,” said one ad that ran in
the Houston Chronicle. “And, our emergency care centers and emergency rooms are
available to everyone 24/7/365, regardless of insurance.”
Houston Methodist is
running the ads because it believes that UnitedHealthcare has not adequately
educated its Methodist patients about their rights and options, Asin said.
UnitedHealthcare
contests that Houston Methodist’s assertion is “meritless” because patients can
call the insurer or go to its website to find out their in-network care
options. Sarah Bearce, a UnitedHealthcare spokesperson, said the ads encourage
UnitedHealthcare customers to keep using Methodist’s ERs and hospitals but
“fail to mention that doing so could result in significantly higher
out-of-pocket costs.”
The amount an
out-of-network patient would have to pay fluctuates based on what kind of
treatments or care they’re receiving, but it could be a “very high difference,”
Bearce said.
For the 100,000
customers out of Houston Methodist’s network, they now must choose if they’d
rather stick with their physicians and pay more, or switch to an in-network
provider and risk interrupting the continuity of care. UnitedHealthcare Medicare Supplement members are
not affected by the dispute.
“There are patients
who get very worried, particularly chronically ill patients who have
longstanding relationships with physicians,” said Vivian Ho, a health economist
at Rice University’s Baker Institute for Public Policy.
Health care
specialists said the Houston Methodist ads essentially remind UnitedHealthcare
members of what has always been the case. For example, under federal law,
anyone can walk into a hospital’s emergency room and receive treatment even if
the facility is not in-network.
But that leaves
patients open to the risk of balance billing, where out-of-network charges not
covered by their insurance are shifted onto a patient. For instance, if an
insurer will only cover $200 of a $1,000 bill by an out-of-network surgical
assistant for a procedure, it’s up to the patient to pay the remaining $800.
A new state law, which
went into effect Jan. 1, barred balance billing for some Texans, most notably
in emergency room care. But only about one in three Texans are protected by the
new law. Those who have federally regulated plans, typically offered by large
employers who self-insure their workers, are not shielded, according to the
Texas Department of Insurance.
Asin, the Houston
Methodist spokeswoman, said the hospital system would not balance bill
UnitedHealthcare members.
“At Houston Methodist
it is not our policy to balance bill,” she said.
For now, the
newspaper notices and radio spots will continue to run. Asin said she does not
know how much the ads cost because the hospital used already purchased
advertising, but plugged in different messages.
Health policy experts
say the ads, while accurate, aren’t giving good advice to consumers, who would
face higher bills.
“There’s a kneejerk
reaction to people always saying the insurer is the bad guy,” Ho said. “I think
these ads are trying to take advantage of that particular opinion, and I don’t
think that is a balanced message.”
Stacey Pogue, a
senior policy analyst at the Center for Public Policy Priorities, a think tank
in Austin, said Houston Methodist’s ads seem aimed at reasssuring
UnitedHealthcare patients, but don’t promise anything groundbreaking.
“They’re not saying
for UnitedHealthcare patients who have to find a new provider, ‘Stay with us
and we’ll bill us,’” Pogue said. “They’re not saying ‘we’ll make sure we pay
more to make sure you stay with us.’”
gwendolyn.wu@chron.com
ttps://www.houstonchronicle.com/business/article/Can-UnitedHealthcare-patients-use-ER-at-Houston-14960660.php
No comments:
Post a Comment