“Every other major health system in the Cincinnati region, they’re part of our Medicare program,” Marusic said.
Marusic also denied that UnitedHealthcare is dropping academic medical centers like UC Health as part of a larger trend. Cleveland Clinic and the health insurer started a new contract effective Thursday that determines insurance reimbursement rates for services covered under a government-backed Medicare plan, for example, Marusic said.
UC Health, affiliated with the University of Cincinnati, and UnitedHealthcare were negotiating ahead of an end-of-year deadline to settle a new rate contract. The agreement determines reimbursement rates that UnitedHealthcare pays for services its members receive from UC Health.
A new contract covering commercial insurance patients of the Cincinnati-area hospital system was reached in time. However, a deal has yet to close on Medicare coverage and that part of the agreement expired, affecting about 5,000 patients, according to the health insurer.
Those patients could pay higher, out-of-network insurance rates for UC Health services or choose to get care from other local health providers in the region, the insurer says.
“Even though we’re not able to reach an agreement here, we’re still covering Medicare Advantage members. Nobody’s lost their insurance coverage,” Marusic said.
Medicare members have access to 11 other hospitals and more than 3,000 physicians in the Cincinnati market, Marusic said.
“A majority of physicians practicing at UC Health also have privileges at other hospitals in-network,” he said.
UC Health spokeswoman Diana Lara said the nonprofit hospital system — which operates the Cincinnati region’s only academic medical center and Level One Trauma Center — was disappointed that months of negotiations failed to reach a deal for the affected Medicare patients. It will force thousands of patients to make changes in a rushed and stressful way, Lara said.
Discussions will continue this weekend.
“My team and I are concerned first and foremost about our patients. Our doctors, nurses and the entire UC Health care team are committed to doing all that we can to ensure that our patients continue to receive the continuity and quality of care they need in the safest possible manner,” said Dr. Richard Lofgren, UC Health president and chief executive officer, in a statement.
“I want to ensure every UC Health patient who is currently a UnitedHealthcare Medicare Advantage plan participant that we will continue to do everything that we can to resolve this situation,” Lofgren said.
UnitedHealthcare Medicare supplement and Community Plan members are not affected by this change, said Marusic, of the insurance company. In some cases UnitedHealthcare Medicare Advantage members will be able to receive care from UC Health on an out-of-network basis depending on the type of plan they have, he added. The insurer also advised members to contact the customer care number on the back of their ID card with any questions.
UC Health is advising patients with UnitedHealthcare’s Medicare Advantage plan to call their doctor’s office if there’s a medical concern or health care need. Patients will be granted access to care at emergency departments of University of Cincinnati Medical Center or West Chester Hospital regardless of the outcome of this negotiation process, according to UC Health.
The new commercial contract covers UC Health facilities University of Cincinnati Medical Center, West Chester Hospital, and UC Physicians, a group of nearly 800 doctors, as well as other sites.
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