Tucson area residents who get their health insurance through UnitedHealthcare just lost a major system of local providers.
Efforts to reach a resolution between Northwest Healthcare and UnitedHealthcare failed at midnight Sunday, officials with both for-profit entities confirmed Monday morning.
Northwest Healthcare, which operates both Oro Valley Hospital and Northwest Medical Center, said Monday that UnitedHealthcare “has rejected every proposal we have offered.”
Officials with UnitedHealthcare say both Northwest and its parent company, Tennessee-based Community Health Systems, turned down a five-year agreement offer.
Both sides say they remain committed to finding an acceptable solution.
In the meantime, the now-severed contract affects tens of thousands of patients, most of them on Tucson’s northwest side.
The end of the contract means patients covered by UnitedHealthcare will no longer be able to use their health insurance for services at Northwest Medical Center and Oro Valley Hospital, except for emergencies. And they will also no longer be able to have visits to Northwest Allied Physicians and Northwest Healthcare urgent care centers, among others, covered by their insurance.
Who’s affected
Affected patients include UnitedHealthcare’s Medicaid, Medicare Advantage (not MediGap plans), and individual and employer-sponsored plans. UnitedHealth officials last week said they already had a transition-of-care plan in case the contract wasn’t resolved.
Patients receiving ongoing treatment for special conditions, or women in their third trimester of pregnancy, may be eligible for continuation of care benefits.
“We know that Northwest Healthcare and our providers being forced out of network with United is concerning for our patients with United coverage,” a statement from Northwest spokeswoman Kimberly Chimene says.
“We will continue to work toward an agreement with United. In the meantime, we will help patients navigate this transition and what it means for them.”
Both Northwest Healthcare and UnitedHealthcare have set up websites to provide patients with more information.
Northwest Healthcare officials said they sent out more than 60,000 letters to local patients covered by UnitedHealthcare who have used their facilities in the last year. The insurance company estimates about 46,000 patients are affected.
‘Rejected outright’
UnitedHealthcare is based in Minnesota, but its Phoenix-based Arizona Healthcare CEO, Dave Allazetta, on April 17 said that the company considers itself local and committed to the community. It has more than 7,000 employees in Arizona.
UnitedHealthcare all along has told the Star that the crux of the dispute was with efforts to get Northwest on board with a “value-based care” model that ties reimbursements to quality measures like mortality and readmissions.
“We’re really trying to change the way they are compensated, using the value-based contract. They are asking for apples. We are offering them oranges,” Allazetta said last month.
“What we’re both trying to discuss is a necessity to create a compensation scheme built around quality and performance. It’s not unique. We do it with other hospital facilities, not only in Tucson, but in Phoenix as well.”
On Monday, Northwest officials said they offered to tie their proposed increases in reimbursement to United’s value-based agreement, but that United “rejected that outright and every compromise we offered.”
Northwest officials contend United “is not acting in the best interest of their members or our community,” Chimene wrote.
Transition plan
UnitedHealthcare’s West Region medical director and Tucson resident Dr. Tom Biuso said that moving forward, patients are already getting help finding new providers. They can call the number on the back of their insurance card or go to a company webpage set up for those affected.
“United has been very proactive, where patients can call the number on the back of their card and get help with continuity of care,” Biuso said.
“We have been proactive in helping them find a new physician and then providing continuity of care when it applies.”
Biuso said UnitedHealthcare officials have met with other Tucson-area health systems, and says they are equipped to provide access to care for disrupted patients.
“I’m confident the network is more than adequate to handle the disruption,” he said.
Biuso stressed if someone is acutely ill, they should always go to the nearest emergency facility.
“In an emergency, they can get their care. Also, many patients have an out-of-network benefit where they can access the urgent cares that Northwest has, or one of the physician groups,” he said. “It may not be prohibitive at all, but I can understand how it would make the patient unhappy.”
Biuso said the last time he checked, applications for “continuation of care” have been getting approved at a rate of 90 percent with a turnaround time of three days.
“We’re trying to do everything in our power to mitigate disruption,” Biuso said. “Behind the scenes the contract dialogue still goes on.”
Patients disappointed
Without Northwest Healthcare, patients with UnitedHealthcare who live in north and northwest of Tucson — in areas such as Oro Valley, Marana and SaddleBrooke — are going to find themselves driving 40 minutes or more to get to a provider.
Tucson resident Linda Davis was approved for special continuation of care with UnitedHealthcare to keep her Northwest Healthcare physicians, since she was diagnosed with a rare cancer in October and would like to keep the same doctors.
Her surgeon, primary-care doctor and endocrinologist are all employed by Northwest Allied Physicians, which is part of Northwest Healthcare, her husband, Kevin Davis, said.
The couple has a Medicare Advantage plan through UnitedHealthcare and is hoping to switch insurance companies. Davis said he no longer wants to be covered by UnitedHealthcare.
“I know there are two sides to every story and I am kind of disappointed in Northwest as well,” said Davis, a former hospital administrator. “I just feel like UnitedHealthcare sold us a bill of goods that wasn’t true.”
SaddleBrooke resident Don Jensen was in disbelief Monday afternoon. He’d really been hoping for an agreement. SaddleBrooke residents are facing an hour’s drive each way to seek care outside of the Northwest Healthcare network.
“The fact that they are still talking gives me some hope,” he said.
Tucson insurance broker Raymond Magnuson of Magnuson & Associates said that in some cases, Medicare will allow a special enrollment period. But he has not yet heard if that will be allowed for the Medicare Advantage enrollees affected by the United Healthcare contract.
A response from Medicare was not immediately available Monday afternoon. Regular open enrollment for changing Medicare plans is always at the end of the year, for coverage starting Jan. 1.
Magnuson does have commercial clients — small businesses — that want to change insurers because of the contract failure, and will be able to do that midyear, he said.
“In the next 24 to 48 hours these things will become much more clear,” Magnuson said. “But as we sit here today I’m telling clients to move forward assuming UnitedHealthcare is not in the Northwest network.”
