Unless a resolution is found by November 1, patients in New Orleans—especially those needing long-term care—might encounter out-of-network expenses at eight significant hospitals.
NEW ORLEANS — For many UnitedHealthcare members, hospitals in places like Metairie, the West Bank, New Orleans East, and Downtown could become unaffordable if the ongoing contract disagreement with LCMC Health doesn’t get sorted out soon.
The crux of the negotiations revolves around hospital compensation rates for the services they provide.
This dispute impacts individuals who obtain UnitedHealthcare via their employer or through the Affordable Care Act marketplace.
It also determines whether LCMC hospitals will process out-of-network claims, even for services rendered by a doctor based within their facility.
LCMC claims that UnitedHealthcare wants to offer rates lower than the inflation rate. Conversely, UnitedHealthcare argues that their reimbursements are at competitive market levels.
You might have seen the two-page advertisement in Sunday’s paper—LCMC Health and numerous physicians are urging UnitedHealthcare to come to an agreement.
“There’s still a significant gap in our negotiations. If no deal is reached by November 1, it’s quite probable that UnitedHealthcare will exclude LCMC Health hospitals and their doctors from its network, resulting in reduced access for patients,” stated Dr. Mark Klein, chief medical officer and chief physician at Manning Family Children’s.
LCMC operates eight major hospitals in the area:
- East Jefferson General Hospital
- Lakeview Hospital
- Lakeside Hospital
- Manning Family Children
- New Orleans East Hospital
- Touro University Medical Center
- University of New Orleans Medical Center
- West Jefferson Medical Center
“LCMC Health and Manning Family Children, in particular, have been grappling with stagnant reimbursements despite rising costs for too long,” he added.
“We truly wish for an agreement with LCMC; however, our priority is to safeguard employer funds, particularly self-funded entities. We are committed to providing accessible and affordable care to our members in the New Orleans area, and we take that commitment seriously,” remarked Christine O’Brien, executive director of UnitedHealthcare of Louisiana.
As the second-largest health plan in Louisiana, UnitedHealthcare services around 1 million clients. LCMC argues that the affected deal encompasses 30,000 patients. UnitedHealthcare mentions that 70% of its Louisiana members have insurance supplied by their employers.
“This could directly affect the financial health of those businesses and therefore impact their employees significantly,” O’Brien noted.
“It’s been suggested that our position is driven by greed, but we are actually reimbursed at much lower rates compared to our regional competitors, while simultaneously caring for high-complexity patients with serious health issues. We are the most cost-effective provider in the region,” Dr. Klein commented.
LCMC contends that UnitedHealthcare’s payment offerings are lower than those from its competitors.
“That’s simply not true. Our data indicates that they will be compensated competitively within the local hospital system,” O’Brien countered.
This is critical: If you’re a UnitedHealthcare member undergoing extended treatment, like for cancer or pregnancy, and no agreement is achieved by November 1, you must reach out to the number on the back of your insurance card to initiate a Continuing Treatment Program. This is essential for maintaining in-network costs during your treatment; however, you’ll need to arrange this ahead of time.
