BayCare could go out of network for UnitedHealthcare patients Monday; What to know before the deadline

TAMPA, Fla. - Thousands of Tampa Bay area patients are waiting to see whether BayCare and UnitedHealthcare can reach a new contract agreement before a Sunday deadline.

If no agreement is reached by May 31, BayCare doctors, hospitals and services could move out of network for many UnitedHealthcare members starting Monday, June 1.

The first deadline applies to UnitedHealthcare employer-sponsored commercial plans, UnitedHealthcare Medicare Advantage plans and United Behavioral Health, also known as Optum.

A later deadline applies to Medicaid members. UnitedHealthcare Community Plan of Florida members could be affected starting June 15 if the two sides do not reach a deal.

What we know:

The dispute affects about 147,000 UnitedHealthcare customers, though not all members face the same deadline.

Most affected members are tied to the June 1 date for commercial and Medicare Advantage coverage. A smaller group is tied to the June 15 Medicaid deadline.

BayCare and UnitedHealthcare both say they want to avoid disruption for patients. But the two sides have not announced a new agreement.

BayCare says it is trying to protect patients’ ability to continue choosing BayCare physicians, facilities and services. The health system says it is seeking fair reimbursement as costs rise for nurses, medications, medical supplies and other parts of care.

UnitedHealthcare says it wants BayCare to remain in network, but says any new agreement must also keep health care affordable for families and employers.

The core disagreement centers on money.

BayCare says it is seeking reasonable increases that are in line with agreements other insurers have reached with the health system. UnitedHealthcare says BayCare is seeking significant price increases that would raise health care costs.

Neither side has publicly provided the full financial terms of its proposal.

What happens if a deal is not reached?

If no agreement is reached, BayCare could move out of network starting June 1 for many UnitedHealthcare members.

That could mean some patients would pay more to use BayCare doctors, hospitals or services, depending on their plan. Some patients may also need to look for in-network alternatives.

UnitedHealthcare says members would still have access to other hospitals and providers in the Tampa Bay area.

BayCare says patients should keep scheduled appointments and procedures for now.

What patients should do

Patients with UnitedHealthcare coverage should check which plan they have and call the number on the back of their insurance card.

They should ask whether BayCare would be out of network for their specific plan starting June 1, what out-of-pocket costs could change, and whether they have access to other in-network doctors or hospitals.

Patients with upcoming procedures, specialty care or ongoing treatment should also ask whether they may qualify for continuity-of-care protections.

UnitedHealthcare says continuity of care may allow eligible members in active treatment for a serious or complex condition to continue receiving in-network benefits for a limited time after BayCare leaves the network. Members must apply and be approved.

Emergency care would still be covered at the in-network benefit level, even if BayCare moves out of network.

Dig deeper:

FOX 13 contacted BayCare and UnitedHealthcare early Friday morning for updated information.

We asked both sides whether negotiations are still active, whether another meeting or exchange of proposals is scheduled before the Sunday deadline, and whether either side would agree to a short-term extension to avoid disruption for patients.

FOX 13 also asked both sides for more details about how many members fall under the June 1 deadline versus the June 15 Medicaid deadline.

We also asked for more clarity on the financial dispute, including what percentage increase BayCare is seeking and what rate increase UnitedHealthcare has offered.

Why you should care:

Contract disputes between health systems and insurers are not unusual. They are often resolved before patients lose in-network access.

But until a deal is reached, patients are left to make backup plans and sort out what the dispute could mean for their doctors, scheduled care and medical costs.

The most urgent date for many UnitedHealthcare members is Monday, June 1.

The contract deadline is Sunday, May 31.

Health Care