Thousands of metro-area residents may be forced to pick new hospitals and doctors – or pay 50 percent or more of the cost of care – after a breakdown in contract-renewal talks between hospital operator HCA Inc. and insurer United Healthcare.
Negotiators for HCA, the metro area’s largest hospital chain, and United, the state’s largest insurance provider, called off talks Wednesday morning, said Linda Kanamine, a spokeswoman for HCA.
The current contract expires at midnight tonight.
United, based in Minneapolis, counts about 850,000 members statewide, with a majority living in the metro area. As many as 30,000 people insured through United have received care at HCA hospitals in Colorado within the past year, said Tyler Mason, a United spokesman.
Further talks are possible but none have been scheduled, said Kanamine and Mason.
United members with questions about coverage should call the customer-service number on the back of their insurance cards, Mason said.
Without a contract renewal or an extension, HCA’s HealthOne facilities would be considered “out of network” for United members, including PacifiCare and SecureHorizons members.
Emergency services at HCA facilities would still be covered. Also covered under “Continuity of Care benefits” would be “qualifying acute conditions,” such as “end-stage renal disease, non- surgical cancer therapy and symptomatic AIDS,” according to an Aug. 8 letter from United.
However, United members seeking care at HealthOne facilities for elective procedures after the contract ends could be asked to pay as much as 100 percent of the bill, said Mason.
That means most would seek care elsewhere.
“I’m going to have to change my doctor and my kids are going to have to change their doctor,” said Anne Easton, 30, of Highlands Ranch. “What kills me is we’ve been paying a high premium to pick our doctors, and now we can’t.”
She said she will consider switching insurance companies.
Easton and her two children, ages 1 and 3, receive care at Sky Ridge Medical Center in Lone Tree. Sky Ridge is one of seven metro-area hospitals – along with 10 surgical centers – that are co-owned and operated by HCA in the metro area under the name HealthOne. Other HCA hospitals include Presbyterian/St. Luke’s Medical Center and Rose Medical Center. Last year, HealthOne served nearly 1 million patients in Colorado.
Shannon Siwiec, a 29-year-old real estate agent, is concerned about changing all her doctors and troubled by the possibility that she won’t be able to go to two hospitals convenient to her University of Denver-area home: Swedish Medical Center and Rose Hospital.
“All my doctors are in Health One,” she said. “Now I will have to change my doctors. My dermatologist, general practitioner and gynecologist – the whole nine yards – they all share information and I thought that was a plus. You pay a premium for this. It’s not cheap. When I found out, I was really angry.”
Dr. Rick May, president of the Colorado Medical Society, said recently that a contract impasse would affect more than just United members and HealthOne facilities. He said United members forced to seek care at other hospitals could potentially overload those facilities. Plus, physicians working at unfamiliar hospitals – and with new support staffs – “puts patients at risk.”
David Rivera, Colorado’s commissioner of insurance, has signed off on United’s plan to ensure adequate patient care if a deal can’t be reached.
He has also met with representatives from non-HCA facilities throughout the metro area to ensure enough beds and staffing are in place to handle United members seeking care.
United and HCA have been negotiating for months in Colorado, Florida and other markets.
HCA, based in Nashville, Tenn., has proposed a single-digit rate increase in reimbursement rates which it says are needed to keep pace with escalating costs for medical devices and technology, staffing and drugs. Kanamine of HCA said United’s proposal is below reimbursement rates paid by other insurance providers, including Aetna, Anthem, Cigna and Sloans Lake.
United counters that HCA’s proposal would raise insurance premiums. “Having met HCA’s demands would have placed an unacceptable burden on employers and individual purchasers of health care,” said Mason.
Staff writer Dave Curtin contributed to this report.
Staff writer Will Shanley can be reached at 303-954-1260 or wshanley@denverpost.com.
Contract talks fail between insurer, HCA hospitals
The contract between health care provider HCA Inc. and insurer United Healthcare is set to expire at midnight tonight. Here’s what you need to know:
What happened?
Contract-renewal talks appear to be at an impasse, which means HCA’s HealthOne facilities in Colorado will soon be considered “out of network” for United members.
What does that mean for me?
If you’re one of the 850,000 Coloradans covered by United or its affiliates – PacifiCare and Secure Horizons – the insurer would no longer cover elective treatments at HCA facilities. United would continue to cover emergencies – and “qualifying acute conditions” under “Continuity of Care benefits.”
Which facilities are affected?
Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center and Spalding Rehabilitation Hospital, plus 10 HCA surgical centers.
Where can I get more information?
United is encouraging members to call the customer-service number on the back of their insurance cards.
HCA said it plans to establish a phone number to answer patient questions about eligibility and coverage options. Information can also be found at www.HealthOneCares.com.
– Staff writer Will Shanley
A photo caption associated with this story has been corrected is online archive. Originally, it mentioned National Jewish Hospital as one of those affected by the impasse in negotiations. Affected facilities include: the Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center and Spalding Rehabilitation Hospital, plus 10 HCA surgical centers.
