CCH won’t cover some UnitedHealthcare patients

Nov. 03--Medicare Advantage patients on UnitedHealthcare may see higher out-of-pocket costs at Central Carolina Hospital as the hospital renegotiates its contract with the insurance company.

Central Carolina Hospital announced Oct. 8 it could not guarantee it would remain an in-network provider in 2019.

Beginnning Jan. 1, 2019, depending on the health plan UnitedHealthcare patients have, they could find themselves no longer covered for any medical care at Central Carolina beyond emergency services; facing higher co-pays for annual physicals and dental exams; or facing higher costs for prescription drugs.

Members of HMO plans like the AARP MedicareComplete Plan 1, for example, are not covered for any medical care by out-of-network providers, and will have to pay for any physician care, specialist care, hospital stays, blood tests or scans at Central Carolina Hospital out-of-pocket, from the UnitedHealthcare website. Members of PPO plans like the UnitedHealthcare Dual Complete RP plan, on the other hand, are partially covered for out-of-network care but could still face much higher out-of-pocket costs as their co-pays or co-insurance payments jump. Many Medicare Advantage plans offer a cap on annual out-of-pocket expenses, but with out-of-network care, that cap could go from $0 to $10,000.

The open enrollment period for Medicare Advantage plans, which provide all the benefits of Medicare Parts A and B and are offered by private companies, is from Oct. 15 to Dec. 7. If patients covered by UnitedHealthcare do not re-enroll in a different Medicare Advantage plan by that time, they may have to look for in-network providers of medical care elsewhere.

One of the Medicare Advantage plans affected by the hospital's negotiation with UnitedHealthcare is the North Carolina State Health Plan for Medicare-eligible retired state employees and teachers. Because of the way the UnitedHealthcare Group Medicare Advantage plan is designed, however, state retirees who are members will not be affected.

"Our Medicare Advantage plan is a passive network, which means that there's no in- or out-of-network provider," said North Carolina Department of State Treasurer spokesman Frank Lester. "It just has to be willing to file on behalf of the member."

In other words, members of this plan have the same out-of-pocket expense with in- or out-of-network providers, as long as the provider participates in Medicare and is willing to treat the patient.

"No matter what happens, there will be no change for our Medicare Advantage members on the UnitedHealthcare program," Lester said.

After retired state employees and teachers expressed concern over their continuing coverage, Central Carolina Hospital posted a statement on its Facebook page Monday to this effect, reassuring retirees that its contract negotiations with UnitedHealthcare would have no effect on their coverage for 2019.

Central Carolina Hospital encouraged Medicare patients with questions or concerns about their 2019 health insurance coverage to call the Medicare Helpline at 855-581-8943. The N.C. Department of Insurance is also running a helpline for those enrolling or re-enrolling in Medicare at 1-855-408-1212. The UnitedHealthcare helpline is 855-859-0966.

All residents eligible for Medicare can enroll or change their health insurance coverage plan for 2019 at HealthCare.gov. The open enrollment period for Medicare is from Oct. 15 to Dec. 15, while the deadline to enroll in a Medicare Advantage plan is Dec. 7.

There are local resources available to residents who have questions about Medicare enrollment as well. The NC Navigator Consortium, led by Legal Aid of North Carolina, is making health insurance Navigators available at a variety of locations to answer questions and help residents choose plans and complete the enrollment process.

Appointments are required and can be made by calling 855-733-3711 or by registering online at ncnavigator.net.

Reach Staff Writer Jasmine Gallup at 919-718-1217.

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