Page 2 - Boca ViewPointe - September '19
P. 2

Page 2, Viewpointe                                                 September 2019

      Boca Raton Hospital – UnitedHealthcare Update

      No News Is Bad News                                doctors and patients to accommodate
                                                         new elective UnitedHealthcare cases
      By Arthur Dermer, Volunteer                        at  one  of  the  nearby  in-network
                                                         Baptist  Health  South  Florida
         During the past  TWO                            facilities in the United Healthcare
      MONTHS  there  have  been                          network. (Bethesda Medical Center
      numerous media reports                             in Boynton is one of 9 such hospitals
      regarding the Boca Raton                           in that network).
      Regional Hospital’s contract                          You  should  be  aware  that  the
      with UnitedHealthcare. That                        Hospital  is  encouraging  United
      contract expired June 30,                          Healthcare patients to stay in touch
      2019.  On  July  1,  2019  the                     with  their  doctors. As  of  July  1,
      Boca Raton Regional Hospital                       2019,  ALL  United  Healthcare
      became part of the Baptist                         plans  (except  United’s  Medicare  Boca Raton Regional Hospital
      Health System. You should                          Supplemental  plans)  are  out  of
      be aware that BAPTIST HEALTH SOUTH FLORIDA is      network with Boca Raton Regional Hospital. The plans   supplementary plans) are out of network. The plans that are
      the partner and lead negotiator for Boca Regional Hospital   that are out of network with Boca Raton Regional Hospital   out of network include all commercial Medicare plans. If this
      in its dealings with United Healthcare. It is working with   include almost all commercial plans. If this sounds confusing   sounds confusing contact UnitedHealthcare for clarification.
      United Healthcare to reach a resolution of a conflict that has   I recommend you contact your local providers to insure that      Question: Will your physician’s participation status
      been ongoing for the past few months. There is very deep   you receive the most up-to-date answers to your important   with United Healthcare be affected? I have been told that at
      concern, anger and fear among many residents of Boca Pointe   questions.                             this time there have been no changes. However, should you
      regarding the unsettled contract between Baptist Health and      Patients covered by United Healthcare who were in the   have any questions about your doctor’s participation with
      United Healthcare. To that point I have received over 30   hospital prior to June 30 or who are in rehabilitation or   UnitedHealthcare you should contact your doctor directly
      calls in the last few weeks regarding this troubling situation.   midway through their treatment plan should be aware of the   for more information.
      As someone who has been involved with the hospital as a   following:                                    Boca Raton Regional Hospital has had a long-standing
      volunteer for almost 20 years, I want to try to clarify recent      If you have already started to receive care at the hospital   relationship  with  United  Healthcare.  It  was  working
      events so that you may have a better understanding of what   you may be allowed to complete your scheduled care if you   diligently to reach a new agreement. Residents should,
      is transpiring.                                    fall into one of the following categories:        however, be aware that since July 1, it is Baptist Health South
         At  the  present  time,  there  has  been  NO  FINAL      1. receiving prenatal care during any trimester.  Florida which is responsible for negotiations with United
      RESOLUTION of the economic discussions going on       2. currently receiving radiation or chemotherapy for   Healthcare. The timing for reaching a resolution is unknown
      between the two groups (Baptist and United). Monetarily, the   cancer.                               at this moment. If the services of a hospital is important to you
      two sides are far apart in the negotiations. No compromise      3. currently undergoing a staged surgery for example   and your health care needs, you are encouraged to consider
      seems to be within reach in the immediate future. To help you   breast reconstruction.               choosing a plan that includes Boca Raton Regional Hospital
      better understand the disturbing situation, I will try to clear up      4. if you were admitted for medically necessary services   as an in-network provider at your next open enrollment. A list
      some of the major concerns people have. To that end I have   before July 1, 2019 and will not be discharged until after that   of the Hospital’s accepted insurance plans can be obtained
      had discussions with Jerry Fedele, former President and CEO   date.                                  at the hospital insurance offices.
      of the Hospital, Lincoln Mendez, newly appointed President      In all cases you should contact UnitedHealthcare before      The Boca Community as always been a major supporter
      of the Hospital and Mark Larkin, President of the Hospital   treatment to make sure your needed services are covered. You   and fund raiser for the hospital. However, there is a great
      Foundation. I believe that these men have been working   can call the telephone number on the back of your United   deal of uncertainty and fear among our residents that what
      diligently to get this matter settled as soon as possible.   healthcare member ID card. You may also need to contact   they have always thought would be available to them might
         In an effort to keep you as informed, here are some of the   United Healthcare’s Medical Management department with   be taken away at an age when they need it the most. They
      most frequently asked questions about the ongoing situation.   questions about your continuity of care benefit coverage.  fear losing their doctors and being denied the services which
      Please be aware that negotiations are in flux and the situation      Question: What about emergency room services? With   the hospital provides.
      can change at any time. Be aware that these are complex   regard to emergency services, be aware that all emergency      We hope that the Baptist Health and United Healthcare
      matters so that there may be more intricate details other than   services will continue to be covered by the patient’s insurance   can quickly resolve their differences and put an end to the
      those shown.                                       plan regardless of whether the plan is in network or out of   confusion, concern and anxiety of our residents. Two months
         Question: Is Boca Raton Hospital still accepting United   network with the provider. In addition, patients who have out   seems like it should be enough time for responsible people
      Healthcare as a supplemental insurance to regular Medicare?   of network benefits coverage can choose to receive elective   to reach a settlement. If you need any clarification regarding
      YES. The hospital still accepts United Healthcare Medicare   services at the hospital although they may experience higher   this situation you can call United Health. Hopefully all will
      supplements to traditional Medicare policies. If you are a   cost-sharing for out-of-network providers.  be settled by the next issue of Viewpointe. How much more
      Medicare patient, you should not be concerned regarding      Question: Which United Healthcare plans are affected   time will it take to reach a settlement? I have no idea nor
      this matter. There are no changes affecting you.   by these negotiations? As of July 1, 2019, almost all United   do I have any inside information. However, be assured that
         Question: If you see a doctor who is affiliated with the   Healthcare plans (except UnitedHealthcare as Medicare   updates of this situation will follow as they occur. 
      hospital will they still be taking United Healthcare? Are the
      tests or procedures done at the hospital affected? Are there
      certain United Healthcare policies that the hospital still takes?
         Boca Care doctors and Boca Raton Regional Hospital
      Urgent  Care  Centers  remain  in  network  with  United
      Healthcare at this time. However, Boca Raton Regional
      Hospital and Boca Raton Regional Hospital’s Outpatient
      Diagnostic Imaging Centers are out of network with United
      healthcare as of July 1, 2019. After July 1, 2019 United
      Healthcare will likely not authorize new elective services at
      the hospital that are not part of an ongoing continuation of
      care. Therefore be aware that the Hospital is working with

                            Nicole Marks,
                                Realtor, GRI


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