The Erlanger hospital campus is shown from South Crest Drive.IF THE CONTRACT EXPIRESHere are the dates that different UnitedHealth plans will go out of network if Erlanger decides to terminate its contract with the insurance company.• UnitedHealthcare Community Plan - (For maternity and child coverage) Out of network Oct. 1• UnitedHealthcare Dual Complete - Out of network Oct. 1• UnitedHealthcare commercial insurance - Out of network Jan. 1• UnitedHealthcare Medicare Advantage - Out of network Jan. 1Here are the dates different UnitedHealth plans will go out of network when University Surgical terminates its contract.• UnitedHealthcare Community Plan - Out of network Dec. 2015• UnitedHealthcare commercial insurance - Out of network Nov. 1• UnitedHealthcare Medicare Advantage - Already out of network.
Leann Crane does not care how UnitedHealthcare and Erlanger Health System reach a deal to keep the hospital in the insurer's network.
She just wants them to make one.
Crane has three young daughters, including an 8-year-old with cerebral palsy who requires monthly visits to a neurologist at Erlanger. It is the only children's hospital in the region.
If the insurer and the public hospital cannot resolve a contract dispute by the Sept. 30, then starting next year Crane will have to start driving to Nashville or Knoxville to get her daughter the care she requires.
"I work really hard for my insurance," said Crane, who has a United plan through her job as a call center employee at T-Mobile. "I can't afford to drive miles and miles every month. They have to work out something."
Erlanger officials have said they are at an impasse with United because of chronic reimbursement problems and because the recent rates United has offered for its TennCare plan, known as United CommunityHealth, are "unreasonably" low.
If the two can't make a deal on the TennCare contract, Erlanger officials said they will sever the hospital's commercial and Medicare contracts with the insurer, as well.
A spokeswoman for United has said that the company's role is to "be stewards of taxpayer dollars," and that the hospital had turned down a proffered reimbursement increase.
Leaders from both groups met at Erlanger on Thursday to continue negotiations. Late in the afternoon, hospital leaders said talks would continue.
"We've agreed to continue negotiations into next week, and hope we can reach a fair and reasonable agreement," said Steve Johnson, Erlanger's vice president of payer relations.
United has been sending letters warning members they may soon be out of the hospital network.
People with United coverage through TennCare would see the network change on Oct. 1. Those with commercial insurance would see it on Jan. 1.
Erlanger is not the only major local player looking to call it quits with United.
University Surgical Associates, the region's largest surgery practice with 37 surgeons, will end its contracts with United within the next year, citing chronic frustrations with getting United claims paid.
"With all insurance companies, you have bumps in the road where you fight a little bit and work out your problems," said Dr. Pete Kelley, a surgeon who oversees contracts for the practice. "But with United it just seems like a business model: The harder they make it to get a claim paid, eventually we will stop asking for it."
Molly McMillen, spokeswoman for United, said such an assertion is "simply not accurate." She cited a report card by the American Medical Association that last year ranked United as the No. 1 insurer in terms of claim accuracy.
But both Erlanger and Kelley point to a 2013 payor survey by health communications firm ReviveHealth, which shows hospitals ranked United as worst for overall relations with hospitals, and for honesty and candor.
In the 20 years that Kelley has overseen insurance contracts, he said, United has "always been the most difficult" to do business with.
The final fallout came from a new contract this year. After many denials, the surgeons group had one stipulation, explained practice manager Craig Sarine: To agree on the front end to pay for any medically necessary procedure covered under United's plan, and performed for any verified eligible enrollee.
United would not agree, Sarine said.
"What other business can you do that? It's like going to buy groceries, and then deciding not to pay after you taste them."
Frustrations with the insurer are widespread, said Rae Young Bond, director of the Chattanooga-Hamilton County Medical Society.
"It's safe to say that we receive more complaints related to UnitedHealthcare than any other insurance company," Bond said. "Some of them feel like it's a war of attrition, feeling that each time a claim is denied, a few practices will just give up."
Smaller practices may not have the weight or specialism to throw weight around in such disputes, she said. But University Surgical does, and the fact that the parties could not reach a compromise is telling, she said.
"Our patients get stuck in the middle, and that puts us in a moral and ethical dilemma," Kelley said. "We want to take care of them, but we just cannot afford to continue with things as they are. It's just a bad, ugly situation."
Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.