Health & Family

Carolinas HealthCare to extend benefits if contract talks fail

Carolinas Medical Center, part of Carolinas HealthCare System, is one of the hospitals that will continue to accept patients with UnitedHealthcare insurance as “in-network” for awhile even if the contract expires Saturday.
Carolinas Medical Center, part of Carolinas HealthCare System, is one of the hospitals that will continue to accept patients with UnitedHealthcare insurance as “in-network” for awhile even if the contract expires Saturday. mhames@charlotteobserver.com

As the end of its contract with UnitedHealthcare approaches, Carolinas HealthCare System said Thursday that “an agreement may not be reached by the deadline” Saturday.

If that happens, hospital officials say they’ll continue to provide care for UnitedHealthcare patients – at least for the next two or three months – as if they were not out-of-network.

Negotiations between the insurance company and the hospital system have been in progress for months, and in January, UnitedHealthcare began notifying its customers and brokers of the potential that a new contract might not be reached.

UnitedHealthcare said the hospital system “wants to be paid up to 150 percent more than other hospitals in the Charlotte area for providing the same services.” Carolinas HealthCare said it offered to extend the current contract but UnitedHealthcare “has so far refused.”

If the multiyear contract expires Saturday, it will affect the 12 Charlotte-area hospitals in Carolinas HealthCare and many doctors offices that serve the nearly 80,000 Charlotte-area members covered by UnitedHealthcare.

Carolinas HealthCare said it will provide “continuity of care benefits to our existing patients” if the contract expires. Temporarily, the hospital system will not ask patients to pay the additional out-of-pocket costs that come from being out-of-network.

That will apply to patients with appointments at doctors’ offices in the Charlotte market during March and April (except for Medicare Advantage patients) and for patients receiving treatment at Carolinas HealthCare hospitals in the Charlotte market at least through May 30. The waiver doesn’t apply to Carolinas HealthCare hospitals outside the Charlotte area.

“We have proposed terms that reflect the value of the quality healthcare services we offer, including nationally recognized programs not available anywhere else in the region,” the hospital said in its statement. “Contrary to what (UnitedHealthcare) has said, CHS is attempting to reach agreement on a new contract that is fair and equitable, and we have also proposed to be paid based on our performance on quality measures.

“Our rates also consider the operating costs associated with providing 24/7 care, CHS’s mission as a safety-net provider to care for all patients regardless of ability to pay, and the uncompromising service provided to the community.”

In its letter to brokers and customers, UnitedHealthcare said Carolinas HealthCare has asked to be “paid about $5,300 more for a cardiac catheterization than what they’re paid today.” The insurer also said the hospital has resisted basing part of its reimbursement on achieving certain quality measures and patient outcomes.

On Thursday, in response to the Carolinas HealthCare announcement, UnitedHealthcare issued a statement, which included: “We sent our first proposal to CHS back in June 2014 in hopes we could renew our relationship well before Feb. 28, 2015, but they waited 3 months before responding. Our goal has always been to renew CHS’s participation in our network before Feb. 28, and if CHS shared our focus on the patients we collectively serve they would have engaged with us early on.”

UnitedHealthcare has had a contract with Carolinas HealthCare for more than a decade. Last year, it renewed a contract with Novant Health, the Winston-Salem-based company that owns four hospitals in Mecklenburg County.

If the contract with Carolinas HealthCare expires, UnitedHealthcare members with Medicare supplement plans would not be affected, because they are allowed to go to any doctor. Medicare Advantage participants would be affected, because they would become out-of-network.

Garloch: 704-358-5078

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