The Florida Hospital Association isn't happy with the feds. And it all because of slashed inpatient facility reimbursement rates.
In Florida, federal Pre-existing Condition Insurance Plan program managers tried to cut costs by switching to a provider network run by a unit of UnitedHealth Group Inc..
PCIP managers asked the hospitals to approve an amendment that would charge PCIP patients newly negotiated UnitedHealth network rates, rather than the old, higher rates that many hospitals had already negotiated with the carrier.
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Bill Bell, FHA general counsel, said most of the hospitals that receivd the letter kept their old, higher UnitedHealth rates.
The fact that the PCIP program tried to make the change with an amendment "makes clear the lack of authority for unilaterally changing the reimbursement rates," Bell said. PCIP agency "purports to do what a private party to an agreement could never get way with: pronouncing a unilateral change in reimbursement rates."
Congress provided $5 billion for PCIP as a stop-gap before PPACA coverage-access rules take effect next year.
The average level of claims per enrollee has turned out to be four times higher than expected, and managers began trying to save money earlier this year by re-vamping program rules and switching to smaller, cheaper networks.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
