United Healthcare to sever ties with Memorial Hospital

News-DemocratJune 27, 2013 

A spokesman from United Healthcare said Thursday its contract with Memorial Hospital in Belleville has been terminated.

The contract between the metro-east hospital and the health insurance provider is not set to expire until midnight Sunday. But United Healthcare spokesman Kevin Shermach said the hospital rejected an offer on Tuesday from the health insurance provider that would have provided a "dramatic increase" in reimbursement rates to physicians that "illustrates our desire to keep Memorial Hospital and Memorial Medical Group in our network of participating providers."

"The hospital rejected the offer without counter," Shermach said in a released statement, "and therefore has decided to terminate its network agreement with United Healthcare."

Memorial Hospital Chief Financial Officer Joe Lanius said United Healthcare did not make a new offer.

"On Tuesday, they reiterated that they were not going to change their offer from a week earlier," Lanius said. "That's what happened on Tuesday."

Lanius also said the hospital has not ended its efforts to reach a deal that would "pay fair reimbursement and market rates."

"We're continuing do what we need to do," Lanius said. "If we're not coming to terms, we need to work in transitional care for our patients to be able to tell them what to do."

According to Shermach, Memorial Hospital will no longer be a participating provider with United Healthcare as of Monday morning. This also applies to United Healthcare commercial and Medicare benefit plans. He also said Memorial Medical Group has indicated it will not participate in the United Healthcare commercial and Medicare benefit plans after current agreements expire in September.

Both sides have been in talks for the past three years. Shermach said Memorial Hospital issued its 120-day notice in March with the health insurance provider about the hospital's intent to terminate its network agreement with United Healthcare. In his statement released Thursday, Shermach said United Healthcare has "negotiated in good faith, making every attempt to maintain our long-standing relationship for the benefit of our members and customers."

Lanius said that as of Thursday, the two sides are not close to reaching a new contract.

"We are still pretty far apart," he said.

Lanius has estimated that as many as 10 percent of Memorial Hospital's inpatients have United Healthcare coverage. One is Caseyville resident Beverly Clark, who said she and her husband would be upset if they lost their doctor of the past 15 years.

"You're telling me to go find someone else and seek less quality care," Clark said. "It's an economic game of chicken. The people who will lose most of all is us."

George McClary, of Fairview Heights, is losing four of his five doctors that have monitored his health. The 79-year-old has had throat cancer, suffered a stroke, had triple-bypass surgery and has a pacemaker. He does not want to have to look for new physicians at this point in his life. He also said he and other patients will be the only ones hurt of the two sides cannot renew the contract.

"United Healthcare and Memorial Hospital are the only ones who will benefit from this," McClary said. "We're getting squeezed out of it. They will get the benefits and we're not."

Earlier this month, Belleville's other hospital announced that it was leaving another health care insurance provider. On Monday, St. Elizabeth's Hospital will leave Aetna's network. The insurance company recently sent letters to those covered under Aetna Life Insurance Co. informing them that the Belleville hospital is dropping the provider from its network July 1. Neither Aetna nor the hospital have provided reasons for the termination.

Contact reporter Will Buss at wbuss@bnd.com or 239-2526.

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