Belleville Memorial Hospital Takes on Nation's Largest Insurer

By Doyle, Jim | St Louis Post-Dispatch (MO), May 19, 2013 | Go to article overview

Belleville Memorial Hospital Takes on Nation's Largest Insurer


Doyle, Jim, St Louis Post-Dispatch (MO)


Belleville Memorial Hospital and UnitedHealthcare are moving toward a showdown next month over hospital and physician reimbursement rates.

If an agreement cannot be struck, Memorial and its physicians group will no longer be in the network of the nation's largest insurer.

Such contract disputes are becoming increasingly common as insurers and health providers vie for scarce health care dollars in a sluggish economy.

The contract talks between Memorial and UnitedHealthcare have simmered for the last couple of years, but they turned potentially volatile in recent days as the two sides began to squabble publicly.

"We're certainly struggling over the same dollar," said Joe Lanius, Memorial's chief financial officer. "United is a big plan and wields its size at times. It's a tough plan to negotiate with. It leads to frustration."

Memorial recently sent a form letter to its patients, informing them that its contract with UnitedHealthcare may soon end because the hospital is being paid below-market rates.

"This change could impact your ability to receive care at our hospital and with our physicians," the letter states.

The May 10 letter, signed by Memorial Chief Executive Mark Turner, encourages patients to talk to their employers and also phone or email Steve Walli, president of UnitedHealthcare-Missouri and the River Valley and state their preference for "a network that includes in-network access to Memorial and its providers."

UnitedHealthcare won't discuss the details of its ongoing negotiations with Memorial, but suggests that the hospital's demands are unaffordable.

The insurer "is committed to providing our customers access to quality health care through a broad network of physicians and hospitals at affordable rates," said UnitedHealthcare spokesman Kevin Shermach.

He said the insurer's current contract with Memorial Hospital continues through the end of June, and its contracts with Memorial Medical Group physicians begin to expire at the end of August.

According to a message on Memorial's website, the insurer on average pays the hospital and its physicians group "less than other insurance companies and, in some cases, less than the payments we receive from Medicare."

Memorial's Lanius declined to identify the medical procedures for which the insurer pays rates lower than Medicare.

"United's low payments to our hospital and our physicians is the key issue that must be resolved," Memorial said on its Web page. "This is simply not acceptable, nor is it fair."

According to Memorial, the problem has existed for several years and the hospital has sought unsuccessfully to renegotiate pay increases.

"Having a lower pay stream is hampering our ability to move forward," said Lanius, whose hospital owner the Belleville-based Protestant Memorial Medical Center Inc. plans to build a new 94- bed hospital in Shiloh.

On about March 1, Memorial gave notice to the insurer that unless a satisfactory agreement is reached, the hospital will be "out of network" after June 30.

In other words, patients insured by UnitedHealthcare who receive care at Memorial would have to pay higher, out-of-network charges. The hospital plans to make exceptions for certain pregnancies and chronic conditions.

Lanius said the sticking point is the rate of pay increase for Memorial hospital and Memorial Medical Group of about 63 physicians and two dozen nurses and nurse practitioners.

Such disputes have common themes.

In early 2012, after months of stop-and-go negotiations, Healthlink Inc. and Anthem Blue Cross and Blue Shield in Missouri struck a deal for a four-year managed care contract with St. Louis University and Des Peres hospitals, which are both owned by Dallas- based Tenet Healthcare Corp.

UnitedHealthcare and other major insurers say they are willing to pay fair and reasonable compensation to physicians and hospitals, but they say they can't afford to pay every dollar that doctors demand.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Belleville Memorial Hospital Takes on Nation's Largest Insurer
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.