MFMEC Terminates United Healthcare Contract

     Effective January 1, 2008, Marble Falls Minor Emergency Center will no longer be a participating provider for United Healthcare and Golden Rule insurance.  Also, with the recent acquisition of Pacificare by United Heathcare, this will also affect those insured under the Pacificare banner that do not have access to one of the provider networks that we participate with.

     Marble Falls Minor Emergency Center notified United Healthcare of its intent to terminate the contract May 9, 2007 after careful evaluation of the reimbursements from United Healthcare over the last 3 years.  Dr. Dickey, the Medical Director of MFMEC, explains, “This decision was very difficult to make.  We want as many people in our area to have access to our services.  We know how much they mean to people.  But United Healthcare’s reimbursement on many services where well below the cost to provide those services.” 

    “The current trend in the healthcare insurance marketplace is that insurers with large marked shares attempt to induce providers to accept inadequate reimbursement in the fear that patients otherwise will be diverted from their offices by the insurer. In more urban areas of Texas, United Healthcare is such a company, having a very large share of the insurance market. However, in more rural areas, such as the Texas Hill Country, it is disturbing because United Healthcare has very few providers in their network.  For this reason, Marble Falls Minor Emergency has been the safety net for those insured by United Healthcare. ”

     “The main contentions with United Healthcare’s are their reimbursement on laboratory test and their failure to reimburse for the added cost of delivery of immediate health care to our urgent care patients.  Most insurance companies now recognize the added cost of providing increased staffing for variations in patient flow that are inherent in the delivery of urgent care services.  Countless services that we have provided to United Healthcare patients have paid 10 cents on the dollar or less”.

    “Like anything else, health care is a business.  If we can’t pay the bills, we have to close the doors.  When you have insurance companies that refuse to pay their fair share, you simply have to weed them out until they change their policies. During the last 6 months, United Healthcare had more than ample opportunity to reopen negotiations with us, but declined to do so.”

   “Our hearts go out to those with United Healthcare as their insurance.  We can see them out of network, but they will have to file their own claims and the claims will go toward their out of network deductible.  They are eligible for our prompt pay discount after the contract terminates on January 1, 2008.”

     “I am a great believer in the value of Health Care Saving Accounts (HSAs).  True cost containment occurs when consumers are really in the driver seat of health care expenditures at the point of care.  In many ways, Golden Rule Insurance coupled with an HSA is a novel and very cost effective insurance plan.  However, now that Golden Rule is linked to the United Healthcare provider network, the choices for in-network services are also becoming more limited.  At least those with Golden Rule and an HSA can use their HSA to pay for services even for non-network providers.  Unfortunately, it does not go toward their in-network deductible, but they still see the tax advantage or using their HSA. ”

     ”Hopefully, United Healthcare will soon recognize the great value and cost savings that urgent care offers.  Particularly, when compared to the cost of emergency room services or the potential cost of delay in treatment of a serious illness, urgent care services may be the best value in health care.”