Why UF Health Doesn't Accept United Health Care, The Villages Medicare Advantage Plan
 

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 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.

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.

@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

Very informative - thanks!

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.

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.

True

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.

UHC and UF Health
 

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.

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.

Correct Info
 

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.

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

This is just another reason why a Medicare Supplement Plan may be the best option when your talking out of pocket expenses. Sure you have a monthly premium with it but you can choose your hospital and doctor and there is no doing the referral dance. You also do not have surprises in the form of co-pays that can add up to many times more than a monthly premium. Plan F/G can give you much piece of mind. Your health care is nothing to roll the dice with.

I had an ER visit and went to a UF ER and only had to pay my co-pay.

I just went to Shands/UF Eye clinic and they accepted my Villages Health insurance

My advantage plan has an annual out of pocket maximum. Works out to the same amount. I don’t want to be running all over creation looking for doctors. TV Health is welcome to do that for me.

Change your insurance carrier

If you have Plan F, you may wish to consider switching to Plan G if you can pass the underwriting, if it is required. The only difference is that Plan F includes the $200 annual Part B deductible and Plan G doesn't. However, the difference in premiums might be greater than $200 so there is an overall savings. Similarly with Plan N, the premium difference, compared with Plan F, might be greater than the Part B annual deductible, possible additional copays, and possible excess charges associated with Plan N.

Nonprofit only means they do not have shareholders ... that profits (if any) are retained not distributed. Nonprofits may or may not pay federal business income tax on their mission-related businesses. (They undoubtedly pay many other taxes on unrelated activities, e.g, renting out office space to doctors.). The profit and tax exempt statuses are technically unrelated. Bottom line: All of this has little if any effect on how they negotiate with insurance carriers. Also, just saying ... if the US had a single payer system like all other first-world nations, none of of this would even occur.

I couldn’t agree more. Advantage plans are losing ground. Medigap/Supplemental Plans F or G are the best options.

Has TVH changed in the last two years?
 

Hello, Kahuna, did you just say Florida Blue is accepted by the Villages Health? Are you over 65 years old?
When I switched from UHC VILLAGES I, to Blue, I had to leave the Village Health, can I get back in now?

I couldn't agree more. I too, switched from UHC to Florida Blue on the advice of a SHINE rep.

The specialists fees are $10 less, ($30 instead of $40) and the first few days of a hospital stay are less($150 for days 1 -6 and I think UHC was $250 for the first few days). $2900 Out Of Pocket for the year.

I addition, they give you $75 OTC medications every 3 months instead Of $40 from UHC. I ordered stuff on Monday and got it on Tuesday. WOW!!!

You have access to Moffitt and Shands which is not promoted by UHC, I believe the Daily Sun had posted a comparison of UHC and Florida Blue several day ago.

I went to the Florida Blue office off 101 in the shopping plaza to talk to a Florida Blue rep.

I haven't noticed any change in the level of care! I see my villages doctor as ususal. So far, so good!

I agree that one should check it out.

We have the AARP United healthcare supplemental plan instead of the advantage plan and we can go anywhere, except we cannot get a PCP in the villages. How strange is that. But we can go to all of their specialists in the villages.

I go to a doctor at UF in Gainsville and have medicare and United Healthcare supplement and they take my insurance. No problem at all.

I am 68, have Florida Blue Medicare Advantage and go to TV Health for everything. I am sure they would welcome you back.

When october comes around - consider looking at bcbs!!! I needed a reverse shoulder replacement - determined by local ortho dr in october. Uf shands was closest (gainesville) place to go to for this operation. Had to wait till january to start bcbs coverage - but i was well worth the insurance change!!!

We're not talking about Medicare and supplements, or Medigap, which, of course, are accepted by Shands. We're talking about Shands and The Villages Health United Healthcare Advantage program.

I think RustyP has probably hit on the right answer. Shands and UHC will eventually negotiate something to accommodate the thousands of Villages Health patients with UHC Advantage. But now, if I were thinking of going back to The Villages Healthcare I'd look at Florida Blue.

Moved here almost 3 years ago. TV Health sounded restrictive. They stopped accepting other insurances other than UHC. I had Aetna at the time. They then started accepting other insurances again, I think. I now have UHC (not through TV Health) and have no problem. TV Health ‘regional’ plan really scared me.

Advent Hospital takes United Healthcare in Ocala and I believe Ocala Hodpital does also. Better care there than Villages or Leesburg hospital.

Amen - windy person!!!!!!

IMO it should be against the law for any medical facility to not accept healthcare insurance. IMO that’s why healthcare insurance so ___ —. Lobbyist still own career politicians. This should of been corrected under the ACA. But lobbyist made call to there career puppets and they bowed down to there masters.

My wife says that the F plan WAS the gold standard. You can't get it anymore. She says that maybe you can get a G plan?

Nonprofits of all types, including hospitals are also notorious for paying outrageous salaries and perks to Senior executives and directors.

Not exactly. Essentially, you can get Plan F if you were eligible for Medicare before Jan 1, 2020. If you have another plan, you may need to go through underwriting in order to change to Plan F. For many people, Plan G is a better deal. Read post #21.

Also technically true. however, many non profits source their large cash flow investment needs from bond holders, as well as are renters from hospital reits. However, both bond holders and REITS have convenants or required payments which the hospital must maintain, or they can be evicted, (does happen) or bonds are called, credit ratings are lowered and the cost of future investment or ownership is less certain.

So there is a relationship between customers served, prices negotiated, government reimbursements, commercial payers, depending upon the type of customers you are accepting, and the bond holders, credit ratings for future investment in upgrading old buildings and equipment, and reits for rental fees.

The finances of large service providers is very, very dependent upon the services provided and the margin of the individual services as well as the mix of services and customers.

Safety net hospitals have a large portion of government payment or uninsured, and therefore rely heavily upon government payments, some with greater than 50% of customers are government or uninsured, based upon population of geography served.

So a single concept might satisfy your belief system, the finance world is always much more difficult to balance all the variables to long term success:

Which is easier? running any large organization successfully for 10 years? or going out of business due to a key strategic miss or financial ineptness?

finance guy

When my wife first went on Medicare a so called expert told her that her best option was a supplement plan due to her health issues. She even told her an advantage plan would not cover her. Turned out that so called expert was wrong.
We paid the highest out of pocket health care costs we have ever had to pay while under that supplement plan.
After two years we talked to both UHC and Blue Cross. Both advised her she would be covered under an advantage PPO plan with much lower out of pocket costs.
She has been with AARP UHC PPO for about 3yrs and is very happy with them. Visits to Shands and Smilo Yale Cancer Center have been fully covered.

FloridaBlue Supplement is different than FloridaBlue Advantage
 

I just came back from the Villages Health at Santa Barbara , They DO NOT accept Florida Blue Supplement Plan F or G if you are over 65 years old.