Update on Aug. 31, 2023: A previous version of this story said about 18,000 BCH patients insured by UHC would be affected if an agreement is not made by Oct. 1. That number is now about 13,000. After publishing, BCH said that one plan, PERA, would no longer be affected. PERA represents about 5,000 members.
Some 13,000 Boulder Community Health patients insured by UnitedHealthcare will be scrambling for new doctors and medical facilities come Oct. 1, unless the disputing sides agree on a new contract by then.
Policies won’t be canceled, but failing to agree would leave affected members paying hefty out-of-network charges for all BCH care, according to spokespeople for each side.
That would include not only Foothills Hospital, primary care physicians and clinics, but also specialty care clinics and BCH-owned facilities — 43 separate entities. (Find the the full list at the bottom here.)
Impacted are policyholders for seven UHC Medicare Advantage plans, several dozen employer-sponsored commercial plans, plus group retiree plans and dual special needs plans (an uncommon Medicaid/Medicare combination). (See the list of affected policyholders here, or at the bottom of this story.)
UHC’s traditional Medicare Supplement plans are not affected, said a UHC spokeswoman.
The contract dispute and shifting details are causing widespread alarm and confusion among UHC customers who worry about what could happen to longstanding medical relationships, scheduled surgeries and ongoing therapies. One large insured group, PERA, for instance, was removed this week from the list of those affected.
“We’re all under red alert,” said Elaine Eichel, a retired Boulder Valley School District teacher insured under a UHC Medicare Advantage plan for Colorado PERA, which provides benefits for retired public sector employees. “Do we all have to look for other hospitals, surgeons and primary care physicians? The older we get, the harder it is to deal with this.”
The parties noted that they plan to continue short-term in-network treatment for pregnant women in their second and third trimesters and those now in treatment for serious conditions, such as cancer.
“We have a month yet, and we are in active negotiations,” said the UHC spokeswoman. “If we can’t agree, those that are in the middle of [that serious] care will be able to continue” for a period of time that would be set individually. She advised policyholders to call the phone number on the back of their insurance cards to discuss individual concerns.
The stalemate is due to soaring medical costs related to the Covid pandemic — things like hospitalizations, increased protective gear and staff overtime — combined with rapid increases in the costs of labor, supplies and other expenses. These factors are making it difficult to achieve price stability and predictability, the sides agreed.
“The challenge for both sides in negotiations is predicting inflation,” Bill Munson, BCH’s chief financial officer, told Boulder Reporting Lab. He added that BCH has signed new contracts this year with the other major local insurance players, including Aetna, Humana, Cigna and Anthem Blue Cross.
However, each side said that while it is seeking only fair and competitive rates, the other side is not doing the same. Negotiations began back in February.
Munson said that increases in systemwide expenses locally, as well as nationally, have rocketed about 8% annually in each of the last four years. While Munson said BCH isn’t looking to recoup that full amount, UHC is offering only about half.
“That’s simply not enough to offset the financial impact of inflation. We cannot remain financially stable” without a sizable increase, he said.
“The situation is very similar to what any of us experiences in our personal budget. If I make less money, I have to make up for it somewhere. It puts the hospital in a place where we have to make cuts, hire fewer people, offer less services,” Munson said. “We are trying hard to find offsets, and we’ve made progress, but we can never declare victory.”
United Healthcare, however, said it is “offering market-competitive rate increases that will ensure BCH continues to be fairly compensated. … We remain fully committed to good-faith negotiation and urge BCH to work with us to reach an agreement that is affordable for families and customers in Colorado.”
The insurer said its responsibility is providing policyholders with access to quality healthcare while containing rapidly rising health care costs, because high increases strain the budgets of retirees and employer group customers.
According to UHC, BCH’s proposed rate increases would drive up premiums and out-of-pocket costs for members. They would also raise costs for businesses, in turn affecting companies’ ability to offer quality healthcare to their employees, UHC said.
Donna Sichko of Boulder, who holds an Advantage plan, is among the many angry at both sides. “Five to six weeks’ notice is not reasonable to make other plans. I have seven doctors and six are probably in this. What am I going to do in October” if a contract isn’t worked out, she asked. “I just had cataract surgery — what if I have complications?”
Munson is “cautiously optimistic” a new three-year contract will be reached in time because “both strongly want to continue partnering. We are committed to meet at least weekly.”
The UHC spokeswoman told Boulder Reporting Lab that she is “extremely hopeful. We are fully committed. We are going to stay at the table for as long as it takes.”
But should negotiations fail, the spokeswoman emphasized that UHC has an “ample network” of other hospitals and their affiliates in Boulder County where BCH customers can still receive in-network coverage and services.
“There shouldn’t be new out-of-network costs,” she said, but acknowledged that customers might have to change doctors when switching network providers.
But “nobody likes change,” remarked Jacki Nelson, a Boulder Medicare Advantage policyholder who has been part of the BCH network for 10 years. “It’s very frustrating. BCH is just 10 minutes away. I won’t be happy if I have to go out to Lafayette. As we age, it gets less appealing to drive all over, especially in winter.”
The three women are hoping for a contract settlement, but are frustrated that they may spend September doctor-shopping only to find that it was unnecessary if a new contract is signed.
If talks do fall through, however, they are preparing in different ways. Eichel said she’s still banking on an agreement coming through so will wait until October to do anything. Sichko plans to find a Medicare insurance counselor to work through alternatives, and Nelson is hoping her doctors are on another Advantage plan she’s considering.
“It will all be a lot of work,” Nelson said.
Clarification: An earlier version of the spreadsheet listing plans affected included United Medicare Advantage PPO. BCH removed this plan from its list, after our publication deadline, a company representative said. It has been removed from the spreadsheet above and a sentence has been added to the story to reflect the change.