Negotiations over payment rates are stalled between United Healthcare and Johns Hopkins All Children's Hospital. The result is 10,000 families will now face a future with the hospital as an out of network provider, unless the situation is resolved.
Gavin Shreeve is enjoying a day at Disney. But much of his time is spent tied up with hospital visits.
"Basically his body attacks itself," said Gavin's mom, Christina Shreeve.
The five-year-old has a rare auto-inflammatory disease which has led to surgeries, regular lab testing, and being part of major national studies. The family's visited doctors at five Florida hospitals and has even gone for special genetic tests at Duke University.
"We've been everywhere trying to find a team of doctors that could come together," Shreeve said.
They finally found that team at Johns Hopkins All Children's Hospital in St. Pete.
"This doctor never gave up," said Shreeve.
But now, she fears her son will no longer have access to that care. It's all because of stalled negotiations between her family's insurance company, United Healthcare and the hospital.
United is now making All Children's an out of network provider.
"It's terrifying...This is grown adults filling their pockets and risking children's health," Shreeve said.
The hospital insists the increase in payments it's asking from United, doesn't line anyone's pocket. What it does is bring United much closer to the level nearly all other carriers pay.
"We don't want anyone to suffer, but we can't take an unfair pay rate and then somehow make the same investment in making sure those families can get the care they need," said Dr. Jonathan Ellen, Johns Hopkins All Children's Hospital CEO.
United Healthcare insists it's being bullied into over-paying and is working to connect families to other local in-network providers. In a statement saying in part, "United Healthcare remains focused on members’ continued access to the care they need."
Christina Shreeve, who left her teaching job to take care of her son, says she'll do everything to keep fighting for her child and has a message for United.
"Have a heart. Think of it as if it's their child and somebody told their child they can't have treatment. That they can't see the doctors they need to see," said Shreeve.
The hospital says it's confident it'll reach an agreement with United Healthcare soon.
United Healthcare says families seeking 'continuity of care' temporarily through All Children's can apply for the program through June 9 .
There's also a wealth of information about the changes and their impacts via Johns Hopkins All Children's Hospital.
The following is the full statement from United Healthcare provided to ABC Action News:
“All Children’s is paid competitive rates that are in line with other specialty hospitals in the St. Petersburg area. Despite UnitedHealthcare offering to increase their reimbursement rates by 20 percent, they continue to turn down our offers, insist on a 35 percent raise, and are deferring to an out-of-state consultant to manage the negotiation rather than working directly with our local team to reach a quick resolution.”
- A 20% rate increase will ensure All Children’s is paid competitively and is able to cover the cost of the important services they provide families while ensuring the thousands of local employers who pay the cost of their employees’ medical bills themselves do not experience an unsustainable surge in their health care budget.
- Rates are only one part of this negotiation. All Children’s is also resistant to being paid based on performance, commonly known as “Value-based Care.” Unlike many other hospitals UnitedHealthcare works with in Florida, All Children’s no longer wants to participate in incentive programs that promote better health, better care and lower costs, and instead wants a contract that specifically excludes any portion of their reimbursement being tied to performance or quality measures.
- Our local team remains focused on reaching an agreeable solution, but All Children’s continues to ask that we negotiate with an out-of-state consultant, making these negotiations even more difficult and inefficient. We were expecting greater engagement from All Children’s to reach a quick resolution for the people we collectively serve, but their consultant is resistant to a reasonable compromise.
We are taking two important steps to minimize any impact to UnitedHealthcare members now that All Children’s is an out of network hospital:
- Any UnitedHealthcare member in active treatment for a serious medical condition with an All Children’s physician may qualify for Continuity of Care, which enables them continued in-network coverage for their medical care at All Children’s. Applications are due by June 9.
- UnitedHealthcare will continue to cover trauma and emergency-related services at a member’s in-network benefit level.
UnitedHealthcare is committed to ensuring members have access to the specialty care needed for their children, and all other hospitals in the Pinellas County as well as the Tampa Bay market are participating in our network. Specifically, the other children’s specialty hospitals are in network:
- Children’s Medical Center at Tampa General Hospital
- St. Joseph’s Children’s Hospital – Tampa
Shriners Hospital for Children – Tampa
- For support in finding other in-network hospitals, members can call the customer care telephone number on the back of their medical ID cards or visit myuhc.com
For more information, members can also visit www.uhc.com/johnshopkins-allchildrens .