[Carla B]

Just opened the POA April Bulletin which printed an interesting observation made by UF Health CEO Edward Jimenez who spoke at the March POA meeting and focused on integrating the local hospitals with UF Health Shands.

"Mr. Jimenez was surprised that no one asked about United Healthcare, saying that UF Health does not accept United Medicare because United doesn't want to work with University Hospitals. United has offered to pay only 75% of Medicare (claims)."

So, I suppose this means that patients of TV Health United Health's Medicare Advantage plan will not be going to The Villages Regional or Leesburg Hospitals for treatment in the future?

Sounds like the United Health Care reimbursement rate is miserly, even by Medicare standards. Maybe Moffitt, Mayo and other providers do not accept it for the same reason.

[Debfrommaine]

I understand UHC Advantage Plan in The Villages does accept TVRH and Leesburg (there may be one more I can't think at the moment), but out of network are Shands and Moffit.

[Northwoods]

Originally Posted by Debfrommaine

I understand UHC Advantage Plan in The Villages does accept TVRH and Leesburg (there may be one more I can't think at the moment), but out of network are Shands and Moffit.

This is correct. TVRH does accept UHC Advantage Plan, but Shands does not. Moffitt doesn't either.
I think a number of people have moved from UHC Advantage to FL Blue for that exact reason.

[CoachKandSportsguy]

Healthcare insurance back story: Each insurer negotiates rates with hospital systems for every item for every diagnosis. Medicare govt payments are substantially less than private pay, so a hospital prices private pay to balance medicare / gov't payer with expected mix of payments. So in effect, private payers partially subsidize gov't payer rates, to keep the hospital from going under.

A year ago or so, UH begin offering private pay rates which were below medicare / gov't and many hospital's would go bankrupt by accepting that rate structure. So many systems, including coachk's hospital, refused to accept UH payment structure, as they can't afford the cuts everywhere if they accepted UH, to remain solvent. . . so many people lost their primary care and hospital services they had for many years.

The health care industry is profit seeking, the hospital system is non profit. A hospital is a very large highly regulated business, and to just force the rate structure below a profitable level, where medicare is not profitable by itself, would cause massive labor issues and retention and service level issues. . .

be careful what you wish for, as it might sound like a great plan, but if you don't understand the system, you won't get the results you are expecting. . . .

finance guy

[OrangeBlossomBaby]

Originally Posted by CoachKandSportsguy

Healthcare insurance back story: Each insurer negotiates rates with hospital systems for every item for every diagnosis. Medicare govt payments are substantially less than private pay, so a hospital prices private pay to balance medicare / gov't payer with expected mix of payments. So in effect, private payers partially subsidize gov't payer rates, to keep the hospital from going under.

A year ago or so, UH begin offering private pay rates which were below medicare / gov't and many hospital's would go bankrupt by accepting that rate structure. So many systems, including coachk's hospital, refused to accept UH payment structure, as they can't afford the cuts everywhere if they accepted UH, to remain solvent. . . so many people lost their primary care and hospital services they had for many years.

The health care industry is profit seeking, the hospital system is non profit. A hospital is a very large highly regulated business, and to just force the rate structure below a profitable level, where medicare is not profitable by itself, would cause massive labor issues and retention and service level issues. . .

be careful what you wish for, as it might sound like a great plan, but if you don't understand the system, you won't get the results you are expecting. . . .

finance guy

It might help to also know that not all hospitals are non-profit. In fact, only 2/3 of all hospitals in this country call themselves "non-profit," and that's only for tax purposes. If they're designated non-prof, they don't pay taxes. They can still profit, they just have to meet certain criteria with it.

For instance, the Villages Regional Hospital is now a UF hospital - with UF meaning: University of Florida. Since it's tethered to education, it gets to call itself non-profit even though it turns a profit. But it doesn't pay any tax to anyone, anywhere.

[CoachKandSportsguy]

@OBB,

True, and having healthcare friends who have worked in both, I will say that going from non profit to profit, they are not happy with the concept of forcing profits from patients. . . and having to grow profits. . . and at coachk's hospital, their annual payment from CMS determines their profit or loss for the year, CMS payment is based upon service quality metrics, not any profit metric, Her system is also classified as a safety net hospital which serves a higher proportion of uninsured / medicaid patients, which also gets a reimbursement from the federal government at lower rates, as well as being spun off from a state teaching hospital. State hospitals also have other funding sources.

So the original discussion was only about the private pay revenue/funding sources in relation to the cost structure, regardless of tax status, as both types of tax classification can go bankrupt, if careless with their financial agreements.

CMS = Centers for Medicare and Medicaid

[Altavia]

Very informative - thanks!

[rustyp]

Originally Posted by Carla B

Just opened the POA April Bulletin which printed an interesting observation made by UF Health CEO Edward Jimenez who spoke at the March POA meeting and focused on integrating the local hospitals with UF Health Shands.

"Mr. Jimenez was surprised that no one asked about United Healthcare, saying that UF Health does not accept United Medicare because United doesn't want to work with University Hospitals. United has offered to pay only 75% of Medicare (claims)."

So, I suppose this means that patients of TV Health United Health's Medicare Advantage plan will not be going to The Villages Regional or Leesburg Hospitals for treatment in the future?

Sounds like the United Health Care reimbursement rate is miserly, even by Medicare standards. Maybe Moffitt, Mayo and other providers do not accept it for the same reason.

I'm quite confident the two parties will sync up. It will end up being does the dog wag the tail or does the tail wag the dog. May I suggest United Heath Care Ins Co is the Goliath of this duo.

[l2ridehd]

Interesting. I have UHC The Villages plan and I have been to Shand’s, both Jacksonville and Gainesville, UFH Proton Therepy Institute in Jacksonville, and was covered. I do have the out of Network supplement, but over 90% was covered as in network. And have heard that UFH Orlando is also covered as in network. Although I have no personal experience with the Orlando UFH. This was all 2019 and 2020 so unless something has recently changed I assume I would still be covered. I will find out for sure next month as I have a follow up appointment in Jacksonville.

[Lynnesail]

True

[allsport]

It is always important to note that these plans that are being sold as the best around are getting more money from the government so they can pay providers less and make great profits for their investors and CEO. Forget the health club and get the best insurance available.

[dpscmsgt]

Although Shands does not directly take UHC they can be in network if your in network doctor refers you to Shands. We have had experience with this. My my wife’s Orthopaedic surgeon referred my wife to a super specialist at Shands. When we saw the claim processed as in Network we wondered why. I went to the UHC in Lake Sumter Landing. It turns out that if a in network doctor refers you to an out of network doctor UHC can see the circumstances as in Network. Therefore, our copayment was $50 instead of $70. Zero for the X-rays instead of $7 and zero for the radiologist who read the X-rays. Fortunately for us I am retired military so we have Tricare for life that picks up the copays and any deductibles in or out of network.

[Villages Kahuna]

After several years of subscribing to TVH Medicare Advantage offered by United Health Care, we switched to Florida Blue this year, when it was first accepted by Villages Health.

One important reason was that Moffitt and Shands no longer accepted UHC as of a couple of years ago.

If you examine the benefits and co-pays of Florida Blue you’ll find there are quite a few that are better and cheaper than United Health Care. I’d recommend that you take the time to do the comparison. Better yet, visit the insurance office at any Villages Health office. They are staffed full-time with licensed agents from both companies. The Florida Blue reps can lead you through a comparison.

[gmdds]

We have UHC Advantage Plans and we can go to any of those...Shands, Moffitt, Mayo, Villages Health system, etc.

The difference is that we have a UHC PPO Advantage Plan (AARP) vs. a UHC HMO Advantage Plan (which is The Villages plan). There are whole different reimbursement levels with a PPO vs. HMO.

It not UHC who limits it...it is the plan you chose.

[J1ceasar]

By the way nonprofit does not mean your income should not cover your expenses . It just means that the capital cost to create the business and the people that provided do not expect to earn income from giving and starting the business
. Some people don't understand that system ie your religious buildings and systems still need to have income that covers utilities and wages etc