Below are some frequently asked questions (FAQs) about the continuity of care of patients with UnitedHealthcare as their primary insurance provider. Should you have any further questions, please do not hesitate to reach out to Marlene Borerro at meborrero@houstonmethodist.org or 281.274.7868.
UnitedHealthcare (UHC) FAQs
What happened?
- Houston Methodist and UnitedHealthcare (UHC) were unable to reach an agreement by the Dec. 31 deadline. UHC continued to demands cuts that would have compromised the quality of care we offer our community. They abruptly terminated our 21-year contract, which was previously agreed upon by both parties.
Will negotiations continue?
- Yes. We will begin negotiations this month as an out-of-network facility. We are still hopeful to find resolution on both contracts in the next few months.
Who does this affect?
- UHC patients no longer have in-network access to Houston Methodist hospitals and facilities. The contract for employed doctors terminates on April 1. This does not directly affect private physicians who have privileges at Houston Methodist.
- The termination does not affect patients who have a UHC or AARP Medicare Supplement, you should proceed with scheduling as usual.
What is happening with our contract with Fort Bend ISD?
- Houston Methodist has reached an agreement with UHC regarding FBISD employees and we will continue to provide coverage at in-network benefit levels.
What is Continuity of Care (COC)?
- Continuity of Care (COC) is a process that provides short-term, temporary coverage for care with an out of network provider.
- UHC will consider COC if a change in provider may have adverse effects on the patient’s health.
- UHC does not consider a preference for a particular provider or ongoing monitoring for a chronic condition is not considered COC.
- Examples of services considered for Continuity of Care are:
- Inpatient on date of termination
- Pregnancy, 3rd trimester (some plans cover 2nd trimester)
- Newly diagnosed or relapsed cancer and currently receiving radiation or chemotherapy or reconstruction
- Transplant
- Recent major surgeries in the acute phase or follow up period
- Serious acute conditions in active treatment
- Other serious conditions that require active treatment
Is there a process that will need to be followed for COC?
- UHC requires the patient and physician to sign and submit the COC request.
- Our physician liaisons have been visiting with offices and communicating the process while the physician organization administration is educating their physicians.
- HMSL Patient Access Services is working with corporate managed care to track every application we receive.
What if the patient does not qualify for COC?
- We will continue to schedule patients in 2020 throughout the negotiation process.
- Patients will need be scheduled 3-4 days out to allow verification of UHC plan to be completed.
- UHC patients who have out of network (OON) benefits will owe a higher out of pocket.
- These patients will be allowed to proceed with minimal payment upfront.
- Payment plans options will be available.
- UHC patients who do not have OON benefits will be offered a single case rate agreement during active contract negotiations.
Who should patients, families, office staff or physicians with questions contact?
- Marlene Borrero, Director of Patient Access Services
- Phone: 281.274.7868
- Email: meborrero@houstonmethodist.org
- Sarah Rodgers, Financial Counseling Coordinator
- Phone: 281.276.8968
- Email: serodgers@houstonmethodist.org
- HM Corporate Managed Care
- Phone: 713.441.3278
- Fax: 713.441.4337
- Email: TMHPOManagedCare@houstonmethodist.org
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