Baytown resident Ruth Hughes has a major problem with the standoff between United Healthcare and Houston Methodist Hospital System.
“The problem I have with this whole issue is that it does not affect the people on Medicare that have United through AARP as a supplemental plan,” Hughes said. “I honestly think this is being left out because Methodist’s people want people to get off United.”
Hughes said she visited her doctor and was told she would be out-of-network despite her being on Medicare.
“That is not true since Medicare does not have networks,” Hughes said. “I feel a lot of people do not understand insurance, and a lot of people on Medicare are elderly. I am sure they are really upset right now. If they go somewhere and have to pay $20 extra because they are told they are out of network, that $20 could make a difference if they eat or not since many are living on a fixed income.”
Contract negotiations between United and Houston Methodist fell apart before the deadline of Jan. 1, meaning anyone with the insurance and goes to Houston Methodist’s hospitals, including the one in Baytown, will be charged out-of-network prices.
United Healthcare and Methodist have been trying to come to a deal, but remain at odds over contract renewals.
Houston Methodist claims United Healthcare reduced previously negotiated rates for how much they charge for care.
As for United Healthcare, it claims Houston Methodist charges too much for services.
One issue associated with the failed contract negotiations involves senior citizens being unaware of the differences between Medicare and Advantage Medicare.
United spokeswoman Sarah Bearce explained the difference between the two plans.
“There is a fair amount of confusion, especially among seniors,” Bearce said. “Oftentimes, you will hear a senior citizen say they have a Medicare supplemental through United Healthcare, but they actually are in a Medicare Advantage plan. So it is a confusing topic.”
Bearce said Medicare Advantage is when you take Medicare Parts A and B and combined them into one plan.
“That takes the place of the original Medicare,” she said. “If you have it, typically you will have a network of care providers, and that is going to be similar to what we have if you have a commercial plan. Medicare supplement is a totally different type of plan. If you choose Medicare supplement, you keep the original Medicare, and then you have a supplement plan to help fill in the cost gap that Medicare doesn’t pay. In that case, you do not have a network of providers, so you can use any hospital or doctor that takes Medicare patients. So those folks are not affected by the termination of our agreement with Methodist.”
Bearce said anyone who has a Medicare supplement plan does not have to worry about networks.
“Those people will not experience any change in terms of patterns of care of who they use for care,” Bearce said.
Houston Methodist has put out pamphlets saying if you have Medicare Advantage with United, they encourage you to select a different Medicare Advantage plan during the open enrollment period. The hospital system is included in Aetna, Blue Cross and Blue Shield of Texas, Cigna-Health-Spring, Devoted, Humana, Oscar and TexanPlus (WellCare).
Another related issue involves Houston Methodist running ads saying United members could still come to its emergency rooms and hospitals. However, United said that’s not the whole story.
United says Methodist advertising encourage members to continue using their ERs and hospitals but fail to mention that doing so could result in significantly higher out-of-pocket costs. United urges its members to use in-network ERs whenever possible or they could incur significantly higher out-of-pocket costs if they’re admitted to a Methodist hospital.
“If a patient is treated out-of-network, their out-of-pocket costs will be more,” Stefanie Asin, a Houston Methodist spokesperson, said. “But we will be clear about those costs upfront and work with individuals if necessary on the out-of-pocket amounts.”
The issue of rising medical costs, and attempts to contain those costs by employers, has not just affected Methodist and United. Community Health Choice, a Houston-based company, terminated a contract with Kelsey-Seybold Clinic New Year’s Eve. This March, Cigna is saying it plans to end its contract with Memorial Hermann.
For the latest information, a website and phone number are available for consumers that frequent Methodist hospitals, including the Baytown location, and have United and Optum Health insurance. Visit houstonmethodist.com/united or call 877-493-3228.