Dr. Marvin Dewar has seen many things as an attorney, physician and health care executive. But the CEO and chief medical officer for UF Health Physicians says has never witnessed negotiations with a health care company extend this long.
Saturday marks the beginning of the seventh month that the University of Florida Health system has been out of network with United Healthcare.
That means nearly 75,000 people in Gainesville, Jacksonville and Central Florida are paying substantially higher costs to access medical care if they are insured by United.
Dewar says UF Health and United negotiators are closer to reaching an agreement for how the health care provider will be reimbursed for its Medicaid coverage.
The biggest obstacle is in whether UF Health will be repaid for the Medicaid coverage that was provided while United was out of network.
Medicaid is the joint federal and state program that helps cover medical costs for people with limited income and resources. In Florida, the Agency for Health Care Administration oversees Medicaid.
In January, Duval County had 222,897 people enrolled in Medicaid. At 22.2%, the percentage of residents who are on Medicaid is higher in Duval than in any other county where UF Health maintains a hospital.
What may have a larger effect on patients is the conversation about private insurance.
What separates UF Health and United?
Dewar says the latest United offer, provided in January, does not account for the rise in health care costs since the parties signed their previous contract.
“I do think United has made progress so that they don’t have us going backward anymore,” Dewar said. “But, we may have only moved a tenth of the way there in terms of closing that gap. … There is still a disconnect on the commercial side.
“We still think that a lot of the opportunity — rather than think about it as United might want to think about it about the rate or the price — we still think the opportunity is to narrow the gap so that what we get paid is actually to whatever the contract says, so you don’t have to make up for the 20% to 30% of the care that you provide that you’re not getting (reimbursed) for.”
On its web page about the negotiations, United says its priority is to swiftly finalize an agreement that is affordable.
“We have met with UF Health more than a dozen times over the past few weeks, emphasizing our commitment to reaching an agreement that is affordable for both consumers and employers,” United wrote in a statement to Jacksonville Today. “On January 10, we presented a proposal that included significant compromises. We are still awaiting a counterproposal and urge UF Health to share our sense of urgency in renewing our relationship to ensure Florida families have access to affordable care.”
United and UF Health officials met nine times during January’s final fortnight.
The two parties remain apart.
Effect of rising health care and insurance
In February, Strata Decision Technology, a Chicago-based data analytics firm, released results from a survey of 100 hospital financial leaders across America. It found the biggest concern for this year was maintaining financial stability. The Strata analysis found that financial flexibility would be obtained through the management of expenses — negotiation of rates with insurance payers as well as keeping track of labor costs.
“With labor costs continuing to rise for hospitals and health systems nationwide, many organizations are looking to strike a balance between optimizing care and effectively managing workforce expenses,” the Strata report found.
In 2023, KFF — formerly known as the Kaiser Family Foundation — polled more than 3,600 American adults with health insurance about their experience using their health insurance benefits. Though 81% had either “excellent” or “good’ thoughts about their coverage, the same survey found that 58% of insured adults experienced problems accessing their insurance over the previous year.
“Serious health and financial consequences arise as a direct result of insurance problems, and consumers whose problems include denied claims are far more likely to have needed care delayed or denied, to experience a decline in health status, and to face higher out-of-pocket costs,” the KFF report found.
In October, a month after the end of the hospital-insurer agreement with United, Dewar emphasized, how United was an industry leader in health care denials from hospital systems.
At that time, Dewar said the consistent denial of UF Health claims was one of the biggest impediments to reaching an agreement.
“United leads the health insurance industry — this is leading from behind,” Dewar told Jacksonville Today last fall. “They lead with denials about a third of the claims that come in, which is a staggering figure that creates a lot of work to get those denials overturned. Sometimes, you get them overturned. But, at the very least, it delays your payment and it costs you to have to go get those paid.”
"Defend," "Depose," "Deny"
Since the impasse began, United Healthcare chief executive Brian Thompson was fatally shot in New York City while walking to an investor’s conference.
Thompson’s death shocked some and delighted others. Reportedly, the bullets that felled Thompson had the words, “defend,” “depose” and “deny” written on them.
UF Health officials were mortified.
“That’s a tragedy and should not have happened,” Dewar said this year. “And no one should try to create a justification for anything like that to an individual who was somebody’s father, somebody’s son and somebody’s spouse.”
Thompson’s death Dec. 4 led to a national conversation about insurance claim denials in the health care industry.
Days later, United responded with a fact sheet about its claims approval rate. The company professed that it approves and pays 90% of its claims and those that it does not are due to administrative errors that can be corrected.
Dewar says that is not the case with UF Health. He says United denies between 20% and 30% of the claims the health care system files with the insurance company.
“We are not relishing the position of being out of network,” Dewar said. “But, we still have to have that gap closed on the commercial side. As soon as Unted can come forward with some real way of closing that gap — whether its by increasing the (reimbursement) rates or tangibly doing things (different), they could do it either way. There are multiple ways to close the gap. We just have to have that gap closed.
“As soon as they do, we’ll be back in network.”
Disclosure: United Healthcare is the health insurance provider for WJCT Public Media, the parent organization of Jacksonville Today.
