Venice hospital closure limits insurance options

VENICE — A lot of factors go into choosing the hospital in which to receive medical care, but one of the biggest is where your insurance is accepted.

Even with insurance coverage, a hospital stay can leave you with substantial financial liability, depending on your treatment and length of stay. Without it … .

Medical expenses top the list of reasons people file bankruptcy.

All area facilities accept Medicare and most accept most major health insurance plans and managed-care programs, but there are gaps.

Sometimes a plan or program isn't accepted at all, while other times the hospital might be considered "out of network," meaning it doesn't have a contract with your provider but will get some reimbursement.

It likely means a higher deductible and a higher out-of-pocket limit for you, though.

The pending Sept. 22 closure of ShorePoint Health Venice poses problems for local health care consumers on two fronts.

First, the loss of their neighborhood hospital is a concern even with another one only a few miles away.

"We are retired and on fixed income," Larry Ivey said via email. "Now we have to worry about getting off the island. Will the bridge be up? Before we could walk if we had to. Now it could be an expensive ambulance ride.

"I personally have been to the emergency room twice. Both times my wife drove me there. One time I was admitted, the other I was treated and released. It was a good experience and nice to know it was right here on the island of Venice.

"When my wife had her operation, she had a room on the third floor that had a view of the Gulf. We could sit and hold hands while watching the Gulf. She said the food was great and nurses friendly, efficient and knowledgeable."

The second concern is for people insured by Cigna, one of the biggest health insurance companies in the country: ShorePoint accepted it but Sarasota Memorial Hospital-Venice, the other hospital in the city, doesn't.

The two companies couldn't come to terms on a contract a couple of years ago, leaving ShorePoint — then called Venice Regional Bayfront Health — as the only option for Cigna patients in the city.

There are alternatives, but they involve travel when patients — and their families — generally prefer to be as close to home as possible.

The ShorePoint hospitals in Port Charlotte and Punta Gorda are remaining open, and both accept Cigna. So do the HCA hospitals in Sarasota (Doctors Hospital), Englewood and Port Charlotte (Fawcett Hospital).

But ShorePoint in Venice also accepted Multiplan, Prestige Health Choice, Wellcare and Freedom Health, none of which is listed as accepted on the SMH website.

According to its hospitals' websites, HCA doesn't take Prestige either, though Lakewood Ranch Medical Center, in Manatee County, does.

The HCA hospitals do accept Multiplan and Freedom Health, while the other ShorePoint facilities take Prestige and Wellcare.

In a crisis, a lack of insurance won't get you turned away from an emergency room as long as the facility accepts Medicare.

Under the federal Emergency Medical Treatment and Labor Act, you're entitled to a medical screening examination to determine whether you have an emergency medical condition; treatment to either resolve it or stabilize you; and a transfer to another hospital if it can't.

A receiving hospital with the appropriate capabilities can't turn you away either. EMTALA no longer applies if you're admitted, however.

SMH's website has this advice for patients not experiencing a medical emergency: "Because health insurance coverage can differ from plan to plan, even under the same insurer, we highly recommend contacting your insurance company's member services for information specific to your plan's coverage and to confirm your plan's in-network providers and facilities."