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What is happening between Houston Methodist and UnitedHealthcare?

Houston Methodist has had a contract in place with UnitedHealthcare (United) for more than 20 years. The insurance company abruptly and unilaterally terminated our contract effective midnight on Dec. 31, 2019. This decision includes a termination of Medicare Advantage, commercial plans and employed physicians.

Houston Methodist will not agree to reduce rates that were already negotiated by United. We will not compromise our ability to provide high-quality patient care, advanced technology, expanded programs and services, and recruiting and retaining clinicians.

Furthermore, we cannot agree to reductions that limit our mission as an academic medical center, which is a commitment to research, education and patient care.

 

How does this affect me?

This negotiation impacts all patients with United commercial (employer-sponsored) and United Medicare Advantage insurance plans. If a new agreement is not reached, Houston Methodist hospitals and facilities will be out-of-network on January 1, 2020, and our doctors will be out-of-network on April 1, 2020. Optum is being directed by United to send any new transplant patients to a different provider starting Oct. 14, 2019. If you have questions, please call Susan Zylicz at Houston Methodist J.C. Walter Transplant Center, 713.441.5481.

 

What can I do?

PATIENTS WITH UNITEDHEALTHCARE
Contact your employer’s Human Resources department to request a plan that includes Houston Methodist. We also encourage you to call United and express your concern.

 

PATIENTS WITH UNITED MEDICARE ADVANTAGE
You can protect your access to Houston Methodist in 2020 by selecting a different Medicare Advantage plan during the open enrollment period, which runs from Oct.15 to Dec. 7, 2019. Before making a choice, please check with your physicians to confirm they participate in the plan. Houston Methodist is included in the following plans for 2020:

 

  • Aetna: 855.335.1407 (TTY 711)
  • Blue Cross and Blue Shield of Texas: 866.292.6745 (TTY 711)
  • Cigna-HealthSpring: 855.984.1401 (TTY 711)
  • Devoted: 800.728.9756 (TTY 711)
  • Humana: 866.945.4481 (TTY 711)
  • Oscar: 855.672.2710 (TTY 711)
  • TexanPlus (WellCare): 866.556.4607 (TTY 711)

 

Is the United Medicare Supplement affected?

No, only the United Medicare Advantage plan is affected. The United Medicare SUPPLEMENT (listed on your insurance card as MEDICARE SUPPLEMENT PLAN or MEDICARE SUPPLEMENT COVERAGE), is part of the basic Medicare plan that pays the out-of-pocket portion of the patient’s care.

 

Are Medicare Advantage group plans affected?

No, Medicare Advantage group plans are not affected by this termination. Please check with your Human Resources department before accessing services.

 

What if I have questions about Medicare Advantage or the Medicare Supplement?

For questions about Medicare, or if you need assistance choosing another Medicare Advantage plan, please call:

 

 
Can I switch my insurance to keep in-network access to Houston Methodist?

We encourage our patients to contact their employers’ Human Resources department about insurance plan options. Houston Methodist still contracts with all the other major insurance carriers.

 

If I choose to receive care on or after January 1, 2020, and Houston Methodist is out of network with United, will I pay more?

Your financial obligation depends on your medical benefit plan. Please check with United to understand your specific out-of-pocket costs. We also offer a robust financial assistance program for our patients. For more information, please call our dedicated patient information line at 877.493.3228.

 

What does it mean for patients to “pay out-of-network rates”?

While all health plans are different, receiving care from an out-of-network physician or at an out-of-network hospital can sometimes cost more. We encourage you to call the number on your United insurance card to understand your financial responsibility. For more information, please call our dedicated patient information line at 877.493.3228.

 

Can I still see my doctor?

Yes, for now. United has terminated in-network access to our employed physicians beginning on April 1, 2020. To be sure your doctors are covered, you should ask if they are employed or affiliated with Houston Methodist. 

 

I am a new transplant patient. How does this affect me?

As of Oct. 14, 2019, new United transplant patients who use the Optum network are being redirected to a different transplant provider. If you have questions, please call Susan Zylicz at Houston Methodist J.C. Walter Transplant Center, 713.441.5481.

 

What if I have an appointment or surgery scheduled on or after January 1, 2020, and Houston Methodist hasn’t come to an agreement with United?

United members’ in-network access to care at Houston Methodist will vary based on your specific out-of-network benefits. We encourage our patients with United insurance to call their doctor’s office to possibly reschedule appointments or surgeries prior to January 1, 2020, to ensure in-network care is received. If we do not reach an agreement with United, you may qualify for United’s Continuity of Care benefits for a designated period of time. Call the customer service phone number on your United insurance card to see if you qualify.

 

What if I am pregnant or receiving treatment for a special condition on or after January 1, 2020, and Houston Methodist hasn’t come to an agreement with United?

Certain patients, including those who are hospitalized, pregnant, or undergoing an active course of treatment, prior to the contract end date, may be able to continue receiving care for a limited time through United’s Continuity of Care benefits. Call the customer service phone number on your United insurance card to see if you qualify. Use this form through January 30, 2020, to apply for Continuity of Care. 

 

What if I have an emergency on or after January 1, 2020, and Houston Methodist is out of United’s provider network?

Emergency care is not impacted by our negotiations. Patients should always visit the nearest Emergency Room in the event of a medical emergency.  Emergency care will always be treated as in-network until the patient is considered stable. Once stable, patients have a choice to either continue care with Houston Methodist at the higher out-of-pocket cost or be transferred to a hospital that is in United’s provider network.

 

What if I am in the hospital when Houston Methodist’s contract with United ends on January 1, 2020?

If you are already admitted to our hospital or facilities prior to January 1, 2020, and we become an out-of-network provider, you will be covered at in-network rates through the end of your inpatient stay.

 

How can I get my medical records?

Please contact medical records from Monday through Friday, from 7:30 a.m. – 4:30 p.m. at 713.441.4176. 

 

What about United’s claim that Houston Methodist is too expensive?
United is sharing misleading data based on specifically selected data points to support their narrative. We have third party information that shows we are in line with our market. Statistics from the RAND Corp., a think tank in Santa Monica, Calif., place Houston Methodist’s costs in the mid-range of health care systems in Texas.

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