How UnitedHealthcare and Boca Regional dispute affects coverage

Two entities providing clarification to patients as they continue to negotiate

UnitedHealthcare policy holders who use Boca Regional Hospital expressed concern about medical coverage over the last week after the hospital announced its contract with the insurer had expired on June 30. Now, the two entities are providing clarification to patients as they continue to negotiate.

The hospital’s inability to negotiate a new contract with UnitedHealthcare by June 30 left about 17,500 patients scrambling to find another medical facility or go out of network.

Boca Regional, part of the Baptist Health system as of July 1, has been in negotiations with UnitedHealthcare, the nation’s largest health insurer, for the last month regarding a replacement agreement to its contract with the insurer. The two continue to negotiate, and no deal has been reached at this time. On Tuesday, the two entities offered additional information in response to community concerns:

Are patients seeing doctors affiliated with Boca Regional still covered?

The termination of the contract impacts only the hospital agreement, not the physician agreements. If the UnitedHealthcare member is seeing a physician affiliated with Boca Regional and that physician participates with UnitedHealthcare, then the patient is covered for the care they receive for their visit. However, the patient would not be covered for procedures or tests done at the hospital.

BocaCare doctors and Boca Raton Regional Hospital Urgent Care Centers remain in-network with UnitedHealthcare at this time.

Are there UnitedHealthcare policies that the hospital is still taking?

The Boca Regional Hospital and Boca Raton Hospital Outpatient Diagnostic Imaging Centers are currently out of network for United Healthcare commercial, Medicare Advantage and Medicaid benefit plans as well as out-ofstate, Neighborhood Health and Oxford plans.

United Healthcare members enrolled in Medicare Supplemental plans are not impacted and continue to have network access to the hospital.

If a United Healthcare member has out-of-network benefits and Boca Raton Regional Hospital agrees to see that member, they may be able to continue receiving care at the hospital, but may face higher out-of-pocket costs.

If I seek services at another hospital, will I be able to have my existing physician treat me there?

You should check with your physician.

If Boca Regional’s contract with United Healthcare expired June 30 and people are admitted to the hospital after that date who have a United Healthcare policy, what happens?

If a United Healthcare member has not been approved for Continuity of Care and received elective services at the hospital after the contract expired, they may face higher outof-pocket costs.

Continuity of Care may be available to any individuals who were in active treatment at Boca Raton Regional Hospital prior to July 1, providing continued in-network benefits for a period of time despite the hospital going out of network. Members should call the number on the back of their ID card to see if they are eligible.

Since July 1, United Healthcare is not authorizing new elective services at Boca Raton Regional Hospital that are not part of an ongoing continuation of care episode. Baptist Health, which has taken over Boca Regional Hospital, says it is working with doctors to accommodate new elective United Healthcare cases at one of its other Baptist Health South Florida facilities in the United Healthcare network.

How will coverage be handled for patients in the hospital with United Healthcare prior to June 30, who are in rehabilitation or mid-stay?

Patients who have already started to receive care at Boca Raton Regional Hospital may be allowed to complete their scheduled care under their in-network United Healthcare benefits within the following guidelines:

Prenatal care during any trimester;

Receiving a course of radiation or chemotherapy for cancer;

Undergoing a staged surgery (e.g. breast reconstruction);

Admitted under in-network benefits for medically necessary services before July 1, 2019, and who will not be discharged until after that date.

Can patients with United Healthcare receive emergency care at Boca Raton Regional Hospital after July 1?

Emergency services should be covered by the patient’s insurance plan regardless of whether the plan is in-network or outof-network with the provider.

Where can I get more information about coverage?

Contact United Healthcare before treatment to make sure services are covered by calling the telephone number on the back of the United Healthcare member ID card. You may also need to contact United Healthcare’s Medical Management Department with questions about Continuity of Care benefit coverage.

What is the probability that Boca Regional Hospital and United Healthcare will reach a new agreement?

The two remain in negotiation but whether they reach a resolution is unknown at this time. Boca Raton Regional Hospital’s has made available a list of accepted insurance plans.