Dr. Marvin Dewar has seen many things as a lawyer, doctor and health care director. But the CEO and Chief Medical Officer for UF Health Physicians says that he has never witnessed negotiations with a health care company that has been extended for a long time.
On Saturday, the beginning of the seventh month that the health system of the University of Florida did not have a network with United Healthcare.
This means that nearly 75,000 people in GaineSville, Jacksonville and Central Florida pay considerably higher costs for access to medical care if they are insured by United.
Dewar says that UF Health and United negotiators are closer to reaching an agreement for how the caregiver will be reimbursed for his Medicaid coverage.
The biggest obstacle is whether UF Health will be repaid for the Medicaid coverage that was provided while United was outside the network.
Medicaid is the joint federal and state program that helps to cover medical costs for people with a limited income and resources. In Florida, the Agency for Health Care Administration supervises Medicaid.
In January, Duval County had registered 222,897 people for Medicaid. With 22.2%, the percentage of residents on Medicaid is higher in Duval than in any other province where UF Health maintains a hospital.
What can have a greater effect on patients is the conversation about private insurance.
What does UF Health and United separate?
Dewar says that the last United offer, which was provided in January, does not take into account the increase in healthcare costs, since the parties have signed their previous contract.
“I think United has made progress so that they don’t let us deteriorate,” said Dewar. “But we may have only moved a tenth of the road in terms of closing that gorge. … there is still a disconnection on the commercial side.
“We still think that much of the opportunity – instead of thinking about it as United might think about the rate or price – we still think that the chance is to limit the gap, so that what we are paid is actually what the contract says, so you do not have to (repay) the 20% of the care you offer).”
On his webpage about the negotiations, United says that his priority is to quickly complete an agreement that is affordable.
“In recent weeks we have met a dozen times more than a dozen times, with emphasis on our dedication to reach an agreement that is affordable for both consumers and employers,” United wrote today in a statement to Jacksonville. “On January 10 we presented a proposal that included significant compromises. We are still waiting for a contraproposal and at UF health to share our sense of urgency when renewing our relationship to ensure that families in Florida have access to affordable care. ”
United and UF health officials met nine times in the last two weeks of January.
The two parties remain apart.
Effect of rising health care and insurance
In February, Strata Decision Technology, a data analysis company established in Chicago, published results of a study among 100 financial leaders in the hospital throughout America. It turned out that the greatest care for this year was maintaining financial stability. The strata analysis showed that financial flexibility would be obtained by the management of expenditure – negotiation of rates with insurance payers and keeping track of labor costs.
“Now that labor costs continue to rise for national hospitals and health systems, many organizations want to find a balance between optimizing care and effective managing of personnel costs,” the Strata report showed.
In 2023, KFF – previously known as the Kaiser Family Foundation – interviewed more than 3,600 American adults with health insurance about their experience using their health insurance. Although 81% had ‘excellent’ or ‘good’ thoughts about their coverage, the same survey showed that 58% of the insured adults encountered problems to gain access to their insurance in the previous year.
“Serious health and financial consequences arise such as a direct consequence of insurance problems, and consumers whose problems have been rejected claims, among other things, have a much more chance of having delayed or rejected the required care, to experience a decrease in health status and to experience higher out-of-pocket costs,” thought the KFF report.
In October, a month after the end of the hospital insurer’s agreement with United, Dewar emphasized how United an industrial leader was in the denominations of health care from hospital systems.
At that time, Dewar said that the consistent denial of UF health claims was one of the greatest obstacles to reach an agreement.
“United leads the health insurance sector – this is leading from behind,” Dewar told Jacksonville last fall. “They lead with denials about a third of the claims that come in, which is a stunning figure who creates a lot of work to get those denials destroyed. Sometimes you get them destroyed. But at least it slows down your payment and it takes you to have to pay it. ”
“Defend”, “drop off”, “deny”
Since the impasse started, Brian Thompson, chief executive of the United Healthcare, became deadly shot in New York City while walking to an investor conference.
Thompson’s death shocked some and delighted others. Allegedly the bullets that Thompson fell had written the words ‘defending’, ‘depose’ and ‘denying’ on them.
UF health officials were terrified.
“That is a tragedy and should not have happened,” Dewar said this year. “And nobody should try to create a justification for something like a person who was someone’s father, someone’s son and someone’s husband.”
Thompson’s death 4 December led to a national interview about refusing insurance claims in health care.
Days later, United responded with a fact sheet about his claims approval percentage. The company claimed that it approves and pays 90% of its claims and that is not due to administrative errors that can be corrected.
Dewar says this is not the case with UF Health. He says that United denies between 20% and 30% of the claims that the health care system at the insurance company dosse.
“We don’t enjoy the position to be out of the network,” said Dewar. “But we still have to have closed that gap on the commercial side. As soon as Unted can come forward with a real way to close that gap – whether it is by raising the (reimbursements) rates or doing tangible things (otherwise), they can do it anyway. There are several ways to close the gap. We just have to have closed that gap.
“As soon as they do that, we are back in the network.”
Publication: United Healthcare is the health insurer for WJCT Public Media, the parent organization of Jacksonville today.
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