Information for Patients with UnitedHealthcare Insurance

(Updated 3/14/08)

This Q & A will provide answers to questions regarding the change in University Hospital's participation as a provider of services for United Healthcare clients. As always, if you have additional questions regarding continuing your care at University Hospital, please call financial services at (315) 464-8078 or (315) 464-8086.

Questions and Answers

Q. Why did University Hospital terminate its participation with United Healthcare?

A. This decision was reached after several years of difficulties in collecting payments on claims.  The outstanding balance due the Hospital is now over $1.5 million and the unpaid claims have been turned over to the Office of the Attorney General.

Q. How am I affected if I have coverage through the Empire Plan?

A. The Hospital has a separate contractual relationship with United Healthcare Empire Plan which is not affected by the termination notice served to United.

Q. When does this termination become effective? (Updated 3/14/08)

A. The New York State Department of Health mandated termination date has now been extended from April 20, 2008 to April 28, 2008.  In order to avoid disruption in services to our patients, University Hospital met with United Healthcare and agreed to a short extension of the termination date in order to give United an opportunity to deliver on its commitment to pay the unpaid claims and to reach agreement on a new contractual arrangement.  United Healthcare will still be required to provide the thirty-day notification to United Healthcare subscribers as required by regulation.  This means that any services scheduled after that date at University Hospital will be considered by United Healthcare to be provided at a non-participating facility.  Please contact United Healthcare to confirm if an authorization is needed for care provided at University Hospital, if the services will be covered, or if you need to reschedule at another participating facility.

Q. If I have United Healthcare coverage how will I be affected?

A. The termination affects all Commercial products including EPO, PPO, and POS; HMO products including Select, Select + Choice, and Choice+; and the governmental product AmeriChoice including Family Health Plus, and Child Health Plus.

Q. If I have one of the Commercial or HMO products listed above what does this mean? (Updated 3/14/08)

A.  Effective April 29, 2008 University Hospital will be considered a non-participating provider and any services you receive here will be considered to be out-of-network by United Healthcare.  If you choose to come to University Hospital you will have a higher patient responsibility than if you received services at a participating facility.  You should check with your employer to confirm when the enrollment period begins if you wish to select another insurer for coverage.           

Q. What are my options if I subscribe to AmeriChoice, UHC Family Health Plus, or UHC Child Health Plus?

A. If you wish to continue receiving services from University Hospital all of your non-emergent care will require a preauthorization from United Healthcare.  If you do not receive a preauthorization for care, the Hospital will ask you to sign a form indicating that you accept financial responsibility for the care you are to receive.  You also have the right to  re-enroll in a plan with whom the Hospital participates such as Total Care, Fidelis, or Blue Choice Options.

Q.  How do I re-enroll in another Medicaid HMO Plan? (Updated 3/13/08)

A. You must first disenroll from Americhoice which can be done by contacting the Onondaga County Department of Social Services.  Please contact Ms. Barndollar at (315) 435-2928 Ext. 180 and if the line is busy you may call (315) 435-3525.  Please provide your name and phone number and someone from the County will contact you to discuss your options.

Q. Am I affected if I have Medicare and supplemental coverage through another plan such as AARP that is administered by United Healthcare?

A.  No, the termination does not apply to supplemental policies which cover deductibles and coinsurance balances after Medicare.

Q. What if I am in the middle of a course of treatment? (Updated 3/14/08)

A. Coverage of certain treatments may be provided through July 27, 2008 if the services are considered to be an ongoing course of treatment.  Coverage must be requested by the patient  from United Healthcare and preauthorized by them.  It is best for you to contact United Healthcare/Americhoice for confirmation of coverage.

Q.  What if my physician participates with United Healthcare and the Hospital doesn’t?  Can he/she continue to refer me to University Hospital for services after April 20, 2008? (Updated 3/14/08)

A. No, if you receive services only provided at the physician’s office they will continue to be covered by United Healthcare.  If you require additional diagnostic testing or a procedure, you must be referred to a participating facility or you will be subject to the provisions identified above.

Q. What if I require emergency care?  Can I still seek care at University Hospital? 

A.  University Hospital will provide care to you in the Emergency Room.  Any further treatment or admission required by AmeriChoice members must be authorized by United Healthcare.  Any subsequent admission to the Hospital or diagnostic testing required by Commercial subscribers will be subject to the provisions identified above. 

Q. Will the Hospital consider participating with United Healthcare in the future?

A. The Hospital must receive payment for all unpaid claims for services that the Hospital has already provided to United Healthcare members.  Once United Healthcare has satisfied its financial responsibilities the Hospital intends to resume its discussions on a future contract.

Q. Is United Healthcare the only payor with whom the Hospital doesn’t participate?

A. No, there are other payors with whom the Hospital does not participate.  This was a difficult decision to reach and was made only after several years of United’s failure to correct their payment practices.  We regret any hardship this causes our patients and hope we can help them through this transition.

Q. Who should I call at University Hospital if I have any questions regarding this matter?

A. Please contact the Financial Services Department at (315) 464-8078 or (315) 464-8086.   You should also contact United Healthcare at the number provided on your membership card for further information.