Tuesday, August 08, 2006

Battle Royal

Locally, the Blues just settled a dispute with Piedmont hospital and their docs over network pricing. What this meant was, for a little over a month you could continue to use the same docs & hospital as before, but your out of pocket was going to be more.

In some cases, a lot more.

Two years ago in Atlanta we had the same kind of showdown. Once again Blue was the carrier but Tenet hospitals were on the other side of the bargaining table. That dispute lasted about 2 months.

Now this.

Thousands of Denver-area patients may need to find a new hospital because of a contracting quarrel between a giant insurer and a hospital system.
HealthOne, parent company of seven metro-area hospitals and 10 surgery centers, is warring with United Healthcare over reimbursement rates.

On Tuesday, the company sent a letter to its 3,500 affiliated doctors, warning that its contract with United may end on Aug. 31. From then on, HealthOne facilities would be "out of network" for United Healthcare's nearly 1 million Colorado members.

"We are far apart on many issues," the letter said, "and we will not continue as participating providers unless we agree on acceptable terms."

The HealthOne contract affects all of United's business: its HMOs, PPOs and PacifiCare Secure Horizon's business.

Likewise HealthOne, a joint venture between nonprofit HealthOne Alliance and for-profit HCA Inc., gets 9 percent of its inpatient volume from United. Some 3,200 of its own employees have health insurance through United Healthcare.

The pair have been negotiating for months

Every time this happens, patients get squeezed. If it hasn't happened to you yet, just wait.
blog comments powered by Disqus