Thousands of UnitedHealthcare members in central Florida may soon lose access to in-network care at Orlando Health amid stalled contract negotiations.
United’s contract with Orlando Health Physicians and Hospitals expires on July 31, and if the two groups cannot reach an agreement before then, most services will not be covered for people on the following plans, starting August 1: individual employer-sponsored plans; Medicare benefit, including a Group Retiree PPO plan; and Medicaid, including the Dual Special Needs Plan.
After months of negotiating the new terms, with less than two weeks left, both sides accused the other of stalling the negotiations, making misleading statements about the negotiations and making unreasonable proposals.
United Healthcare sent letters to about 74,000 members who had recently received care through Orlando Health, warning them that they were at risk of losing access to care. Orlando Health also sent out letters to patients suggesting they contact United to urge them to speed up negotiations.
United spokesperson Cole Manbeck on Tuesday shared a written statement saying Orlando Health is proposing a sharp price increase that will result in higher member premiums and out-of-pocket expenses, translating into millions in healthcare costs for local businesses.
“We are proposing price increases that will ensure that Orlando Health will continue to be compensated fairly and appropriately. Our top priority is to reach an agreement that guarantees uninterrupted access to quality, affordable care. We urge Orlando Health to join us at the negotiating table and make a realistic proposal that Florida families and employers can afford. bear it,” the statement read.
United cited payment rates as the main sticking point in these negotiations. In addition to disagreements over reimbursement rates, Orlando Health is fighting certain United policies that make it difficult for patients to get care, said Michele Napier, senior vice president and chief revenue officer for Orlando Health.
She said United denied the claims more than any other motive.
“Rates are important. The policies, United Health Care policies, are unfair to patients and our physicians,” Napier said. “…they have worse behavior than any of the health plans in their denial, in their policies, in their prior authorizations.”
Both United Health Care and Orlando Health said they are committed to meeting with the other side as often as it takes to reach a new agreement before the deadline, and that their top priority will be continued care for vulnerable patients if their 20-year partnership lapses.
“We’re willing to talk to United to resolve this issue. We’re being reasonable in our request. We’re being rational in wanting to change policy. And I’ll spend whatever amount of time they want to talk at any time, day or night,” Napier said.
If Orlando Health’s partnership with United ends, emergency care will still be covered, says United’s website. In addition, people who are currently being treated for a serious medical condition such as cancer, or who are pregnant, can apply for continued coverage for ongoing treatment at the Orlando Health, United website.
But many other Central Florida residents may need to find a new doctor. Orlando Health is the second largest healthcare chain in the area after AdventHealth Central Florida. The Orlando Health System includes 29 hospitals and emergency departments, and employs more than 1,200 physicians.
This worst-case scenario has happened many times in Florida.
In 2022, members of UnitedHealthcare in South Florida lost coverage in the Broward Health system for six months after the health system and insurance company failed to renegotiate a new contract, forcing thousands to seek care elsewhere or continue to see their out-of-network doctor, the newspaper reported. South Florida Sun Sentinel announced in November that a new contract had been agreed.
United Healthcare Plan members will remain in the network at other local hospitals, including HCA, Nemours, and AdventHealth.
Ccatherman@orlandosentinel.com; CECatherman Twitter
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