Orlando Health, United patients could lose coverage at midnight [Orlando Sentinel]

With just hours to go until UnitedHealthcare and Orlando Health’s contract expires, the two groups have not reached an agreement.

Thousands of Central Florida members stand to lose medical coverage if the insurer and the provider cannot come to an agreement by midnight Monday.

“I’ve just been feeling scared, and anxious and angry that we’re being put in this situation,” said Danielle Rutherford, whose 7-year-old daughter has been a cancer patient for years at Orlando Health Arnold Palmer Hospital for Children.

The insurance giant has been negotiating a new contract for months with Orlando Health, the region’s second-largest health care chain. Both organizations have told members and patients during this time that they were optimistic a contract would be reached, but now time is running out. Though there has been a flurry of activity and new proposals exchanged over the last few days, there’s still no agreement.

“Orlando Health continues to work with United Healthcare to negotiate a fair agreement.  As of today, critical elements remain open,” said Michele Napier, senior vice president and chief revenue officer of Orlando Health, in a statement provided over email.

If the contract is not extended, 74,000 Central Florida customers who get care at Orlando Health may be out of network starting Tuesday. This includes people on employer-sponsored and individual plans; Medicare Advantage, including the Group Retiree PPO plan; and Medicaid, including the Dual Special Needs Plan, according to a website United created to keep members updated on the negotiations.

Orlando Health patients may lose UnitedHealthcare coverage amid stalled contract dispute

Both groups have said they will try to ensure patients don’t need to pause or delay treatment. People who are undergoing treatment for certain medical conditions, including cancer or pregnancy, can apply to temporarily keep receiving coverage at Orlando Health if the contract expires, United’s website states. 

Rutherford’s daughter qualifies for continuing coverage, and she has had multiple conversations with United representatives in an attempt to ensure that her daughter can continue her cancer care. She said the process has been confusing and far from straightforward.

“It’s not as simple as, you know, the headache of finding a new pediatrician. When you’re dealing with people who have these chronic or complex medical needs, your care team really does become a part of your family,” Rutherford said. “The idea of just stripping that away from us, it’s just so devastating.”

The sticking point, United contends, is reimbursement rates. The two groups have agreed to terms for Medicare Advantage and Medicaid contracts as of Monday, but not the other plans. United spokesperson Cole Manbeck said the insurance company has proposed to Orlando Health that they finalize those contracts, allowing those groups, at least, to continue receiving coverage while negotiations continue.

“Orlando Health refused and is putting some of its most vulnerable patients in the middle of our negotiation presumably in an attempt to use them as leverage so we give into the double-digit price hike demands they’re seeking for our commercial plan,” he said over email. “We remain committed to good-faith negotiation and are in active discussions with Orlando Health.” 

Napier, however, said that statement is misleading and that Orlando Health still has aspects of the Medicaid and Medicare agreement it wishes to change. She says UnitedHealthcare is proposing policies that disadvantage patients, and that those policies apply to the entire contract.

“The rates are important. But the policies, UnitedHealthCare’s policies, are just unfair to patients, to our physicians,” Napier said in a previous interview.

Even if a contract is reached before the deadline, the drawn-out negotiation process and finger-pointing have disappointed many United members, including 34-year-old Dr. Phillips resident Alex Morehead, who is being treated at Orlando Health for heart failure.

“Even if they … just sign at the end of today and this was just all a negotiation tactic, the damage that’s done by scaring people who are already sick into thinking that because of these negotiations, they may not have doctors … is really disappointing,” Morehead said Monday.

Ccatherman@orlandosentinel.com; @CECatherman Twitter

©2023 Orlando Sentinel. Visit orlandosentinel.com. Distributed by Tribune Content Agency, LLC.