Contract cancellation posted on Web site
Listing reasons on the Internet draws fire
When Sarasota (FL) Memorial Hospital’s physician hospital organization (PHO) decided to end its contract with United Healthcare of Florida, it informed its 440 physician members of the decision through its Web site.
The PHO set up the Web site about a year ago as a way of communicating with its members. The site includes a directory of members, fee schedule information, a list of benefits for self-insured groups, links to other sites, and announcements that are of interest to PHO members.
"We put the information on the Web to inform our 440 physicians who are members of our PHO. We wanted to make sure our PHO members knew we had terminated United, and we wanted them to know why. We weren’t trying to reach anyone outside the PHO and were surprised when we found that we had created a stir," explains Gary Hickerson, director of operations for the PHO.
That stir included a letter from the insurance carrier’s corporate legal department asking the PHO to remove the reasons for termination from its Web site. The site now includes only an announcement that the contract has been terminated.
Among the reasons the PHO cited for ending its contract were what is considered a United practice of downcoding, denying claims for services rendered, losing claims and then denying resubmitted claims for failure to file in a timely manner, and improper payment of claims.
"The hospital had a contract for HMO patients, but they were also sending us PPO patients and paying us at HMO rates," Hickerson says.
Other complaints from PHO members included allegations of United’s failure to pay pediatricians properly for immunizations and carving podiatry out of the network in violation of the PHO agreement.