Internet site too detailed for insurer’s comfort
Internet site too detailed for insurer’s comfort
PHO goes public in dropping contract
When Sarasota (FL) Memorial Hospital’s physician-hospital organization decided to end its contract with United Healthcare of Florida, it informed its 440 physician members of the decision over its Web site.
The PHO set up the Web site about a year ago as a way of communicating with its members. The site includes a directory of members, fee schedule information, a list of benefits for self-insured groups, links to other sites, and announcements that are of interest to PHO members.
"We put the information on the Web to inform our 440 physicians who are members of our PHO. We wanted to make sure our PHO members knew we had terminated United and we wanted them to know why. We weren’t trying to reach anyone outside the PHO and were surprised when we found that we had created a stir," says Gary Hickerson, director of operations of the PHO.
The controversy included a letter from the insurance carrier’s legal department asking that the PHO remove the reasons for termination from its Web site. The site now includes only an announcement that the contract has been terminated.
Among the reasons the PHO cited for ending its contract were downcoding, denying claims for services rendered, losing claims and then denying resubmitted claims for failure to file in a timely manner, and improper payment of claims..
"The hospital had a contract for HMO patients, but they were also sending us PPO patients and paying us at HMO rates," Hickerson says.
Other complaints from PHO members included United’s failure to pay pediatricians properly for immunizations and carving podiatry out of the network in violation of the PHO agreement.
The PHO originally canceled the contract with United Healthcare as of March 8 but later extended it to April 17 at the request of an obstetric group that had a number of pregnant women covered by United who were delivering in March and April, Hickerson says.
Insurer represents small business segment
United’s contract represents only a small segment of the PHO’s business, Hickerson says.
"In Sarasota County, the vast majority of business is Medicare fee-for-service. Commercial services is a relatively small segment, and United is one of the smaller ones for us," Hickerson says.
However, the PHO decision could have an effect on United. According to Florida’s department of insurance, United has about 10,000 commercial members in Sarasota County, Hickerson says.
Sarasota Memorial is the second-largest public hospital in Florida and the largest in Sarasota County, he adds.
"Employers are scrambling to find other health plans," he adds.
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