United Healthcare Update

Dear UF Health Patient:

You may have read recent national media coverage about the business practices of for-profit insurance plans that withhold payments and deny claims for patient care services they already preapproved, resulting in more profits for their shareholders.

United Healthcare’s practices have significant clinical and operational impacts on how physicians, nurses, and hospitals can provide you with ongoing compassionate, quality care. Denied claims for preapproved treatments, arbitrarily added paperwork, and random policy changes require your physician and office staff to take time away from patient care to deal with the administrative burden imposed by health plans. These tactics result in higher out-of-pocket costs and delayed access to care for patients like you.

UF Health continues to diligently negotiate in good faith and have increased communications with United Healthcare. However, we have yet to come to terms. UF Health hospitals and physicians remain out of network for United in Gainesville and Jacksonville for commercial and Medicaid Managed Care programs.

We apologize for any disruption to your care. We will continue to keep you updated on our progress and hope to come to acceptable terms as soon as possible. If you have specific questions about whether you qualify for continued coverage and care or for any other information necessary or appropriate for the delivery of your health care services, please contact your health plan.

United Healthcare lists its customer service lines as follows:

• Commercial health plans: 1-866-801-4409 or talk to your benefits representative.
• Medicaid Managed Care: 1-888-716-8787 or check your member identification card.
• Corporate office: 1-800-872-3862.

UF Health is committed to serving as a valuable resource for our communities, and we will continue to provide quality, compassionate care to all patients.

For a list of health plans that include UF Health hospitals and physicians in their provider networks, visit https://UFHealth.org/healthplans for more information.

Sincerely,

UF Health

Note: This communication with you is not for the purpose of solicitation nor is it intended to persuade or convince you to make any changes to your relationship with UF Health or with any health plan under which you are currently enrolled. We want you to have the opportunity to make informed decisions about your health and well-being, and that is the spirit in which this information is provided.

Why is UF Health no longer included in the United network?

At a time when health care systems nationally are shouldering excessive continuous increases in labor, supply, and other expenses while continuing to care for patients, health plans such as United have reported billions in record profits and are adding to insurance claims we file for patients. We are seeking fair and reasonable rates for the quality and compassionate care that our physicians, nurses, and other members of the health care team at UF Health provide to our community every day.

We are working very hard and in good faith to reach an agreement that provides our hospitals and physicians fair and appropriate rates that will return UF Health to the United network.

What UF Health locations are affected?

Hospitals

If you are enrolled in a health plan that currently has an agreement with UF Health but for which UF Health will no longer be a participating provider as of September 1, 2024, your access for non-emergency services to the following facilities may be affected if you have United commercial or Medicaid managed care insurance:

• UF Health Heart & Vascular Hospital
• UF Health Jacksonville
  
• UF Health Neuromedicine Hospital
• UF Health North
• UF Health Shands Cancer Hospital
• UF Health Shands Children’s Hospital
• UF Health Shands Hospital

Medical Groups

• Florida Clinical Practice Association Inc. (FCPA)
• University of Florida Jacksonville Physicians Inc. (UFJPI)

UF Health Central Florida Hospitals

UF Health Spanish Plaines and UF Health Leesburg Hospital are not affected. They are not part of these negotiations.

Affected United Health commercial plans

The following United Healthcare commercial plans are impacted by the current negotiations.

• UHC Carnival Cruise
• UHC GEHA Shared Services
• UHC Surest (BIND) Healthcare
• UMR (non-Jacksonville Plans)
• UMR PGA
• United Healthcare All Savers
• United Healthcare Cover Florida
• United Healthcare Golden Rule
• United Healthcare HMO/POS
• United Healthcare Indemnity
• United Healthcare Oxford
• United Healthcare PPO
• United Healthcare PPO Generic TPA Only

Is United Medicare Advantage affected by these negotiations?

United Medicare plans are not affected by these negotiations.

I have United Health Medicare supplemental insurance (e.g., AARP). Does this affect my access to UF Health hospitals or physicians?

Any patient who has a UHC supplemental plan secondary to a Medicare plan can be seen. It does not have any affect.

I have a United commercial supplemental plan, how are my services affected?

We do not know how UHC will adjudicate these claims; however, we will continue to see any patients with any UHC supplemental plan.

Is there a chance that UF Health could return to the United Health network?

UF Health places great value on its commitment to care for all patients and has been working extremely hard over the past several months to negotiate in good faith with United Healthcare so that UF Health remains a full United network provider. UF Health is waiting for United to respond with a fair and sustainable offer to make that happen. This includes streamlining their claims process and reducing administrative demands.

We are fully committed to engaging in ongoing, productive conversations with United Healthcare and are doing our part to reach an agreement that would prevent unnecessary disruption to continuous access to UF Health physicians, clinical providers, and facilities for thousands of patients with United Healthcare insurance. That is our top priority and our patients’ trust in us is something we do not take lightly.

Continuation of care

How can existing UF Health patients enrolled in health plans not listed above continue to receive services from UF Health?

For certain health conditions, you may have the right to continue receiving care or treatment from UF Health. Your health plan will determine if your condition qualifies for continued care. For example, patients enrolled in United Healthcare health plans who are receiving transplants and behavioral health services are not impacted by current negotiations.

When appropriate and upon request, your UF Health provider may attempt to verify the terms of coverage with your health plan, should you continue to seek services at UF Health. Please contact your health plan with questions.

If I am receiving services from UF Health, how long can I continue to do so for plans that no longer contract with UF Health?

There may be some exceptions to continuity of care. Florida law provides certain time frames for continued coverage and care when medically necessary. Call your health plan for any questions about their benefits.

You are able to see out-of-network providers if you prefer to do so, although there is usually a higher patient copayment. Please check with your health plan to determine what your out-of-network copay would be.

If you have specific questions about whether you qualify for continued coverage and care, if you will have a higher copayment for services, or for any other information necessary or appropriate for the delivery of your health care services, please contact your health plan.

United Healthcare lists its commercial health plan customer service line as 1-866-801-4409. Your health plan telephone number also is typically found on your health insurance card.

When appropriate and upon request, your UF Health provider may attempt to verify the terms of coverage with your health plan, should you continue to seek services at UF Health.

Can you provide a definition of continuity of care?

UF Health anticipates the following would qualify for continuing care. (However, patients must call their payor to confirm continuity of care and also complete and return any paperwork their payor requires.)

UF Health anticipates the following would qualify for continuing care. (However, patients must call their payor to confirm continuity of care and also complete and return any paperwork their payor requires.)

A current UF Health patient who is:

• Receiving treatment for a serious and complex condition from a provider or facility;
• Receiving institutional or inpatient care from a provider or facility;
• Scheduled to undergo nonelective surgery from a provider, including receipt of postoperative care from the provider or facility related to the surgery;
• Pregnant and receiving treatment for the pregnancy from a provider or facility;
• Pregnant and receiving prenatal care through completion of postpartum care;
• Determined to be terminally ill;
• Being actively treated for a condition for which completion of treatment has been deemed medically necessary until: (i) the patient selects another provider; or (ii) the next open enrollment period, whichever is longer — but no longer than 6 months after termination of the contract.
• Under active treatment for a life-threatening condition or a disabling and degenerative condition and continued treatment is medically necessary — but not longer than 6 months after termination (March 1, 2025).

Can you provide examples of conditions that would continue to be covered in case UF Health terminates its commercial and Medicaid Managed Care Contacts with United?

• Emergency care. Patients who present to our emergency rooms for care will continue to be seen.
• Behavioral health and psychiatry services and transplant. We have separate agreements for behavioral health and transplant services with United Healthcare and their subsidiaries such as Optum. We have reached out to the health plan to ensure the message they are providing is consistent to ours, that United patients will remain in-network for behavioral health service and transplant services with UF Health. That means that we can continue to see those patients just as we have been.

For some other patients, requests for continuity of care coverage may be available. Approval of requests for continuity of care coverage comes from United Healthcare. Patients must call their payor to confirm continuity of care and also complete and return any paperwork their payor requires (UF Health will assist in answering the questions on the continuity of care form). In our opinion, the following are examples of clinical care scenarios that present a strong case for continuity of care coverage.

A current UF Health patient who is:

• Receiving ongoing treatment for a serious and complex condition from a provider or facility. Examples would be patients receiving ongoing care for cancer, those who we are managing with advanced heart failure with ventricular assist devices and patients on dialysis
• Receiving institutional or inpatient care from a provider or facility
• Already scheduled to undergo nonelective surgery from a provider, including receipt of postoperative care from the provider or facility related to the surgery
• Pregnant and already receiving treatment for the pregnancy from a provider or facility
• Pregnant and already receiving prenatal care through completion of postpartum care
• Determined to be terminally ill
• Being actively treated for a condition for which completion of treatment has been deemed medically necessary until: (i) the patient selects another provider; or (ii) the next open enrollment period, whichever is longer — but no longer than 6 months after termination of the contract.
• Under active treatment for a life-threatening condition or a disabling and degenerative condition and continued treatment is medically necessary but not longer than 6 months after termination (March 1, 2025).

Frequently asked questions and billing and switching plans and providers

Will I be billed for services?

Each case depends on your health benefits. You are able to see out-of-network providers if you prefer to do so, although there is usually a higher patient copayment. Please check with your health plan to determine what your out-of-network copayment would be.

If you have specific questions about whether you qualify for continued coverage and care, if you will have a higher copayment for services, or for any other information necessary or appropriate for the delivery of your health care services, please contact your health plan.

What if I am willing to pay for out-of-network expenses?

We understand that you would like to pay for the health care service(s) yourself. We want to make sure you are aware of the financial “out-of-pocket” obligation you may experience by doing this. We suggest that you contact your payer so they can fully explain your out-of-pocket obligation, specifically your out-of-network benefits, as well as out-o-pocket maximum that you could need to pay by seeing a provider outside of the United Health Care network. This is going to be important information for you in making your decision.

If you choose to pay using your out of network benefits, it is possible that you may owe as much as your out of pocket maximum, depending upon the services that you receive. For example, the cost United will shift to you for out of network radiology services or for inpatient care will likely be thousands of dollars. We want to make sure you have this information before proceeding with your care.

If a health plan does not include UF Health as a participating provider, will my access to UF Health’s physicians be impacted?

Possibly. If UF Health does not have a participating provider agreement with your health plan, our physicians (Florida Clinical Practice Association Inc., or FCPA, and University of Florida Jacksonville Physicians Inc., or UFJPI) will also not have a participating provider agreement with your health plan for non-emergency services and care on an in-network basis. However, if you have out-of-network benefits, you may be able to continue receiving services from UF Health’s physicians.

When appropriate and upon request, our physicians may attempt to verify the terms of coverage with your health plan, should you continue to seek services from UF Health’s physicians.

Can you help me choose a new health plan physician or other provider?

No, unfortunately we cannot help you select another physician or other provider. That’s a decision only you can make. For any information necessary or appropriate for the delivery of your health care services, please contact your health plan.

If I switch to another physician, will that physician or other provider be able to get my medical records?

Yes, once you have selected a new physician or other provider, your new physician or other provider can request copies of your medical records from UF Health.

How can I switch from my current health plan to another commercial health plan?

Only you can make this decision. We cannot encourage you to do so. Please contact your benefits manager with any questions.

University of Florida students

How are University of Florida Students with United Healthcare coverage impacted by these negotiations?

• For University of Florida students who have a United Healthcare plan through the university’s student health insurance program, the university has worked with UF Health to ensure they will be able to continue to receive care at the University of Florida Student Health Care Center and at all UF Health facilities just as they always have, with no adverse impact, irrespective of the outcome of the UF Health United negotiation.

• The situation is a little more complicated for students who have United Healthcare coverage through their parents’ health insurance plan. UF and UF Health will ensure that even if United does not include UF Health in its network, these students will continue to be able to receive care at the UF Student Health Care Center, with no changes in co-pays or deductibles. Unfortunately, if United does not include UF Health in its network after Sept. 1, 2024, services at other UF Health locations will be out of network. Students and parents should contact their United Healthcare representative to understand out of network co-pay, coinsurance, and deductible responsibilities.