If United Healthcare provides your health insurance, you will soon find yourself paying more out of pocket if you go to Saint Francis Medical Center.
Even though the Medical Center has cut prices 25 percent over the past two years, United is not passing along those savings to you. Instead, it is terminating its contract with Saint Francis. If you go to Saint Francis after March 5, it will be considered out of network and you will be charged the higher out-of-network cost by United, meaning you will pay more out of pocket.
Letters are going out this week to inform patients, and Saint Francis is beginning an ad campaign to inform the public.
At a press conference Monday at the Medical Center, Dr. Maryann Reese, president and chief executive officer of Saint Francis Healthcare System, said the following as she read from a prepared statement:
“On Nov. 6, 2019, United Healthcare issued a termination notice to Saint Francis. On March 5, Saint Francis Medical Center will be out of network with United.
“We are disappointed to share that United has chosen to put profits over patients by terminating its agreement with Saint Francis Medical Center, denying our neighbors access to care in Southeast Missouri. United has created this disruption.
“While other healthcare providers are raising prices, Saint Francis has gone against industry norms by lowering prices 25 percent since 2018. These price decreases are intended for our patients and for our employers. United is benefiting from these price decreases and, instead of passing on the savings to employers, they are increasing premiums while trying to tier and steer Saint Francis Healthcare from United plans.
“In addition to steering patients away from Saint Francis, and even though Saint Francis has provided a 25 percent decrease in rates, United is demanding Saint Francis accept further radical payment cuts. This is unacceptable and puts at risk our ability to deliver Mission-driven healthcare to the communities we are privileged and called to serve.
“United is increasing member premiums, generating billions — that’s billions with a “b” — in profits each quarter. While United is focusing on profitability, Saint Francis remains committed to delivering the accessible, quality care members of our community have known and trusted for 145 years.
“Saint Francis has offered United a fair contract proposal, and we will continue to keep our community informed as negotiations progress. As it stands today, Saint Francis will be out of network with United on March 5, 2020. For the most up-to-date information, we encourage you visit KeepUsIn.com.
“Guided by our Mission to provide a ministry of healing, wellness, quality and love inspired by our faith in Jesus Christ, our priority is and remains to serve all who enter our doors with dignity, compassion, respect and joy.
“Our mission will never change! However, United’s actions jeopardize our ability to maintain services,” Reese said.
About five percent of the patients who go to Saint Francis have United Health-care as their insurance provider, Reese said during a question-and-answer session.
The decision affects 40-50 area businesses, including some that just bought new plans with United, expecting Saint Francis to be in network. Some of the affected businesses have many employees, such as P&G and Southeast Missouri State University.
James Burke, chief administrative officer and general counsel for Saint Francis, said that the Medical Center was “surprised” to receive a letter of termination from United. “Payers and providers are always tough on each other during negotiations,” he noted. United has requested that Saint Francis decrease prices by 20 to 30 percent to stay in network. Saint Francis is making the claim that it has already decreased its prices 25 percent since 2018, and it can’t decrease them that much again. Such additional cuts were deemed “unsustainable rate cuts,” Burke said. “We decided not to do that.”
“It would not be Saint Francis if we took those rate cuts,” added Reese.
Negotiations are still ongoing, but if an agreement is not reached, Saint Francis will be out of network beginning March 5.
The termination by United affects only the contract with the Medical Center; there are separate contracts with physicians who practice there. In those cases, visits with the physicians in their office may still be in-network care, but if it comes to surgery or procedures done at Saint Francis, those procedures will incur out-of-network costs beginning March 5.
Patients who have long-term care, such as cancer patients or pregnancies, can request “continuity of care” so they can continue to come to Saint Francis at in-network rates.
Some insurance brokers who sold United plans to their clients late this past year when United still offered Saint Francis at in-network costs, are upset that United has dropped Saint Francis. Business owners who bought plans for their employees also are upset that they bought a plan that included Saint Francis, and the Medical Center will become out of network partway through their annual contract with United.
“I feel deserted by United,” complained one business owner in the audience. “I feel like I’ve been cheated,” said another.
United has been using the “terminate to negotiate” strategy around the country as it has negotiated with other hospitals, said Burke. “The terminate to negotiate strategy is a broken promise,” he added. Brokers sell — and businesses buy — United’s insurance policies expecting to pay in-network costs to local hospitals, and then United terminates the contracts with those hospitals to force them into lowering their costs that United pays them.
Saint Francis lowered its costs on its own initiative. “We did a survey and we saw where our costs were higher in the region,” Reese explained. So Saint Francis has worked to lower its costs.
“We’ve lowered prices, and it hasn’t affected anyone’s pocketbook,” said Burke.
“—Except United’s” added Reese.
Cost reductions have not been passed on to patients insured by United Healthcare. United has pocketed those cost savings from Saint Francis and has continued to raise premiums for its customers.
Lowering costs too much can affect safety and patient care at Saint Francis. “We’re not going to have the lowest price,” Reese said. If that happened, there would be safety concerns. “Our mission is being appropriately priced,” she said.
In addition to ongoing negotiations with United, Saint Francis is considering the possibility of cutting out the insurance middleman and dealing directly with employers. There is also the possibility of Saint Francis collaborating —instead of competing — with SoutheastHEALTH, which operates the other major hospital in Cape Girardeau.