Amid negotiations, Carolinas HealthCare offers guidance for UnitedHealthcare patients

Three days after their contract expired, Carolinas HealthCare System and UnitedHealthcare are giving patients contradictory information about how their medical expenses will be covered.

Since Sunday, when negotiators failed to reach an agreement, UnitedHealthcare has told members they’re considered “out-of-network,” which means they’ll pay more if they use Carolinas HealthCare hospitals or doctors in the Charlotte area. Exceptions are for patients with emergencies or who are in the midst of treatment (such as chemotherapy or pregnancy) and get “continuity of care approval.”

Carolinas HealthCare says it is waiving the difference between in-network and out-of-network costs for UnitedHealthcare patients for the near future.

On Wednesday, the hospital system released a detailed list of scenarios in which patients will be considered in-network. It includes those with doctor appointments through April 30 as well as surgery and 90-day follow-up care for those who scheduled operations before March 1.

Meanwhile, negotiations are continuing. “We are going to work as long as necessary to try to reach that agreement,” said UnitedHealthcare of the Carolinas CEO Garland Scott. “We understand how disruptive this can be.…Our customers and our employers would like to have access to Carolinas HealthCare System. We want to have a relationship with them going forward.”

UnitedHealthcare customers with questions should call the phone number on their back of their insurance cards, Scott said.

Among the sticking points is the price of care. Scott said Carolinas HealthCare is “consistently higher than other providers for the same services.” He also said the hospital system has resisted basing a portion of reimbursement on achieving certain quality measures and patient outcomes, or so-called “performance-based compensation.”

Carolinas HealthCare spokesperson Amy Murphy has said the hospital system is “completely willing to talk about being paid for quality.” She questioned that the system’s costs are higher than others because “we cannot know what UHC agrees to pay other providers.”

Charlotte-based Duke Energy, which uses UnitedHealthcare to administer insurance plans, has encouraged employees to call the insurance company with questions. None of the plans offered to Duke employees is restricted to a single hospital system, said spokesman Dave Scanzoni.

But he acknowledged it would be frustrating for employees with Carolinas HealthCare doctors to switch to Novant Health, the other major provider in Charlotte, to get in-network coverage. “We continue to urge UHC and CHS to reach an agreement quickly,” Scanzoni said.

This story was originally published March 4, 2015 at 5:31 PM with the headline "Amid negotiations, Carolinas HealthCare offers guidance for UnitedHealthcare patients."