UF Health and insurance company fail to reach agreement, disrupting care for thousands - The Independent Florida Alligator (2024)

Several months of negotiations fell flat today as UF Health’s contract with UnitedHealthcare expired.

The two entities had a Sept. 1 deadline to iron out disagreements over rates, claims processes and administrative demands.

As of this morning, care will be disrupted for about 30,000 Medicaid users statewide after the insurer and health network failed to reach an agreement, according to a statement from United posted publicly.

The company did not specify how many people using commercial plans will be affected. A UF public records request indicates 5,000 to 7,000 students use the company’s Student Resources plan and could be impacted.

UF Health patients began receiving letters in June alerting them to the dispute. The health network said the issue arose due to insurers like United raking in billions in profits, leaving medical systems to shoulder costs.

United, for its part, accused UF Health of demanding a more than 25% price hike in the first year of its commercial contract.

People using both commercial and Medicaid plans will now be out-of-network for UF Health facilities, with the exception of patients at the organization’s psychiatric hospital and Central Florida hospitals.

Medicare users will not be impacted, except for those at UF Health Flagler Hospital in St. Johns County.

UF Health and United are offering differing explanations for the future of the 5,000 to 7,000 UF students enrolled in United’s Student Resources plan.

UF Health said students would not be impacted, regardless of the outcome of negotiations, in a statement given to The Alligator in the week before the contract expired. The university said students receive care through student services, not through UF Health, which are two different contracts.

However, United clarified UF Health will be out of network for the Student Resources plan, which could mean students will face higher cost shares moving forward, and encouraged students to speak to providers to understand additional costs.

In its statement, United said it delivered a proposal to revise commercial plans on Aug. 30 and a contract to allow UF Health to continue participating in its Medicaid network Aug. 31. The insurance company alleges that the health network did not respond to either proposal.

UF Health’s latest proposal, sent Aug. 29, included demands for a 30% price hike over two years and a 20% rate increase in the first year of its contract, United said.

“It remains our goal to reach an agreement that is affordable and restores network access to UF Health,” the company wrote. “However, we need UF Health to approach the negotiating table with a realistic proposal Floridians can afford and to finalize the terms of our Medicaid contract we’ve agreed to.”

UF Health said United offered commercial rates below general inflation and “far below” rising annual costs in its own statement, also issued Sunday.

“United was paying us considerably less than market rates, and those numbers have been declining throughout the past several years,” UF Health wrote. “To make matters worse, they offered no increase to our physician practices for the coming 12 months.”

United did not honor a commitment to previously agreed upon pay rates, UF Health added, writing that authorization processes, complicated billing and claim denials led to reductions in reimbursem*nt and payments lower than other Managed Medicaid payers.

UF Health has made continuity of care agreements for patients, including those with cancer, surgery or pregnancy needs, the statement said.

“We continued to try to reach an agreement right up to the deadline but United insisted upon linking other products to the negotiations and abruptly imposing new conditions and changing language,” Marvin Dewar, chief executive officer of UF Health Physicians, said in the release.

Like the insurance company, the health network reiterated it was open to further negotiations but still awaits a “fair and sustainable offer” for its services.

Contact Zoey Thomas at zthomas@alligator.org. Follow her on X @zoeythomas39.