UnitedHealthcare, which insures a quarter-million Utahns, has dropped two MountainStar Healthcare hospitals in northern Utah from its network. And that has MountainStar officials worried about its other four facilities, which are renegotiating contracts with UnitedHealthcare.
What began with a press release by UnitedHealthcare welcoming Intermountain Healthcare's McKay-Dee Hospital Center of Ogden and Bear River Valley Hospital of Tremonton to its network has spawned an advertising campaign by MountainStar warning that people who sign up for UnitedHealthcare of Utah coverage may have to change doctors or hospitals.
MountainStar is the banner name for HCA — The Healthcare Company's Utah hospitals. Until recently, that company was known as Columbia/HCA, then Columbia was dropped and each state's facilities were allowed to choose their own umbrella name. Utah's network picked MountainStar.
The news release didn't mention that the insurance company has severed its relationship with the Ogden Regional Medical Center and the Brigham City Community Hospital, two of MountainStar's six hospitals, effective the end of this year. And while the other four hospitals are still negotiating with UnitedHealthcare, "it's highly unlikely we'll reach an agreement," said Deb Reiner, spokeswoman for MountainStar.
Because of the volume of business UnitedHealthcare of Utah does (250,000 insured), the impact on MountainStar facilities could be substantial. Steve Bateman, chief executive officer of Ogden Regional, says his hospital received 25 percent of its business from UnitedHealthcare. About 27,000 UnitedHealthcare members live in the Ogden-Brigham City area where the changes have been announced.
The other MountainStar hospitals are Lakeview in Bountiful, St. Mark's in Salt Lake City, Timpanogos Regional in Orem and Mountain View in Payson. It's too early to tell if they will again sign contracts with UnitedHealthcare.
MountainStar's advertisements in local newspapers warn UnitedHealthcare members that they may not be able to use the two northern Utah hospitals — a change whose timing occurred as many employers' open-enrollment periods, during which insurance coverage could be altered, were ending, according to Reiner.
"We just feel very strongly that UnitedHealthcare members need to know this is a very real possibility," Reiner said. "That's why we've taken out the ads. We are getting calls. For instance, I had a woman who said her open enrollment closed last Friday and she's scheduled for knee replacement in January. 'What do I do?' "
UnitedHealthcare describes the impact on the people it insures as minimal. "Our contract with Ogden Regional and Brigham City is going to expire Dec. 31. We simply pursued another option," said Rob Adams, UnitedHealthcare of Utah's CEO. "All the facilities mentioned are good facilities. And 90 percent of the doctors at Ogden Regional have admitting privileges at McKay-Dee. The facilities are close in physical proximity to each other. So there's not a real impact for patients around that. And less than 6 percent of a given population seeks inpatient care, which is what we're talking about."
He said UnitedHealthcare would work with people who already have procedures scheduled or treatment under way. "We're taking a thoughtful approach. Clearly people are in an episode of care, and life doesn't happen so crisply that they couldn't transition after Dec. 31. (Members) are being notified of this change, and they can file for a review of it . . . Change isn't easy and we want to work with them on that."
Adams said UnitedHealthcare is aware of the advertising campaign, and the insurer's goal is to "work through the issues."
"We would love to do business with their other four facilities. We are in discussions with them currently," he said.
He disputed MountainStar ad's assertion that UnitedHealthcare's negotiations with the other four hospitals have been accompanied by "other demands, such as a double-digit decrease in payments to the four remaining MountainStar hospitals."
"This is not about money," Adams said. "They got a substantial increase last year and had requested a substantial increase this year. Both double-digit. We said we prefer to go back to a more moderate position on that. We are supportive of reasonable increases in health-care costs. This is not about that. It's about several issues and the relationship in general."
Bateman said having his hospital dropped from the network was a surprise. "The negotiation in my view was proceeding normally. We were very much surprised by United's decision," which was announced Nov. 9.
And while Reiner warns that other MountainStar hospitals may not be able to reach an agreement with UnitedHealthcare, Bateman believes that may not bother UnitedHealthcare.
He believes that Rocky Mountain Medical Center in Salt Lake (formerly the FHP hospital at 2500 S. State), which was purchased by Tennessee-based Iasis and renovated before recently reopening, may be central to the dispute. Rocky Mountain filed suit against St. Mark's Hospital, which it said was trying to stifle its business. Bateman thinks UnitedHealthcare may have wanted to add the Iasis-owned hospital to its network in Salt Lake but faced "significant obstacles."
And he posits that UnitedHealthcare wants to "cobble together" a network with Iasis hospitals, instead of MountainStar. Since there are no Iasis hospitals in northern Utah, the two IHC hospitals were chosen.
UnitedHealthcare wouldn't confirm or deny it had such plans.
IHC and UnitedHealthcare are the two largest health insurance providers in Utah, so Bateman is troubled by the alliance, which IHC spokesman Daron Cowley characterized as a routine business agreement. "I think that when the two largest HMO insurers in a community join forces to steer business to one hospital over another, you have to worry about the future of competition and health care. There's a ripple effect."
Meanwhile, both MountainStar and UnitedHealthcare say they're trying to reach a contract agreement regarding the other four MountainStar hospitals.
E-mail: lois@desnews.com