If no agreement is reached by November 1, patients across New Orleans may face out-of-network costs. This does not affect people on Medicare or Medicaid.
NEW ORLEANS — Thousands of people who have UnitedHealthcare insurance could find many of the hospitals in Metairie, the Westbank, New Orleans East, and downtown out of financial reach if a contract dispute is not settled soon with LCMC Health.
The negotiations are over how much the hospitals will be reimbursed for services.
The contract dispute affects people who have UnitedHealthcare through work, or on the exchange through the Affordable Care Act.
And it affects whether you pay out of network for LCMC hospitals, not doctor visits, even if the doctor’s clinic is inside a hospital.
LCMC says United wants to pay less than inflation. United says its reimbursement is at market-competitive rates.
You may have noticed the full, two-page ad in Sunday’s newspaper. LCMC Health and dozens of doctors are imploring UnitedHealthcare to come to a contract agreement.
“We’re far apart in the negotiations, and that being the case, as of November 1, it’s very likely that UnitedHealthcare will force LCMC Health hospitals and physicians out of network, denying access at an affordable rate,” explained Dr. Mark Kline, Chief Medical Officer and Physician in Chief at Manning Family Children’s.
LCMC runs eight big hospitals in the metro area.
- East Jefferson General Hospital
- Lakeview Hospital
- Lakeside Hospital
- Manning Family Children’s
- New Orleans East Hospital
- Touro Infirmary
- University Medical Center New Orleans
- West Jefferson Medical Center
“LCMC Health and Manning Family Children’s in particular have been dealing with stagnant reimbursement for a very long time, despite rapidly rising costs,” he added.
“We want to have an agreement with LCMC, but what we’re doing is trying to protect the dollars of our employers, specifically our self-funded employers. We want to offer affordable, accessible care to our members in the New Orleans market, and we take that very seriously,” said Christine O’Brien, Executive Director of United Health Care in Louisiana.
UnitedHealthCare is the second-largest health insurance in Louisiana, with a million clients. LCMC says this contract affects 30,000 patients. UnitedHealthcare says 70 percent of its Louisiana clients are insured through employee benefits.
“So, that would go directly to the bottom line of those businesses and significantly impact not only those businesses but their employees as well,” said O’Brien.
“The contention that we’re, this is somehow greed on our part, we are reimbursed currently at a much lower rate than our competitors across the region, and yet we take care of some of the most complex patients, patients with the most serious medical problems. We are the lowest cost provider across the region,” said Dr. Klein.
LCMC says United is offering a lower rate than competitors.
“Again, that’s not accurate. According to our information, they would be paid competitively with the providers in the hospital systems in our market,” said O’Brien.
United Healthcare released a statement saying:
“LCMC is demanding a more than 40% price hike that would make its hospitals significantly more expensive than any health system in the New Orleans market. Approximately $80 million of the $113 million LCMC is seeking would come out of the operating budgets of local employers, impacting the money they have to grow their business and compensate their employees. We are proposing rate increases that continue to reimburse LCMC at market-competitive rates. We will remain at the negotiating table as long as it takes to reach an agreement that is affordable for Louisiana families and employers. We urge LCMC to join us there and provide a proposal they can afford.”
What can patents do if no agreement is reached?
If you have United and you are under long-term care, like cancer treatment, or pregnancy, if there is no agreement by November 1, you need to call the United number on the back of your insurance card and start a “continuity of care program.” That way, you can stay with that care at the in-network cost and co-pays, but you have to pre-arrange this before you go into the hospital.
- UnitedHealthcare members who are in the middle of treatment at an LCMC hospital for a serious or complex condition are eligible for continuity of care.
- Continuity of care provides continued in-network benefits for a period of time after a hospital leaves our network. Some examples of conditions eligible for continuity of care include but are not limited to:
- Patients who are pregnant
- People currently in active cancer treatment
- UnitedHealthcare members must apply and be approved for continuity of care. They should call the number on their health plan ID card if they need assistance or have questions.
UnitedHealthcare says members will continue to have access to a broad network of hospitals throughout the New Orleans area should LCMC leave our network.
In the event LCMC leaves the network, UnitedHealthcare members should call the number on their health plan ID card if they need assistance finding another provider in our network. They can also search our provider directory at myuhc.com.
For more information, click here.
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