Updates on The St. Joe - UHC Negotiations
Last Updated 7/12/2024
Important information for patients with UnitedHealthcare health insurance plans.
St. Joseph Health System and UnitedHealthcare have been renegotiating their contract for the past several months. As of July 1st, St. Joseph Health System is no longer in-network for UnitedHealthcare members. Our sincere hope is that both sides will come to an agreement in the near future for the good of the 13,000 members that are affected. We hate seeing our clients access to care be limited, and regret the anxiety that this situation is creating.
This change affects members with UnitedHealthcare Medicare Advantage plans and commercial insurance plans. It does not affect clients with Medicare Supplement Insurance like a Plan F, Plan G, or Plan N.
Which Facilities are Impacted?
This change impacts the following facilities and providers;
Saint Joseph Health System – Mishawaka Medical Center
Saint Joseph Health System – Plymouth Medical Center
Saint Joseph Medical Group
Can I Continue to Access Care with St. Joe?
For many of our clients the answer is yes. If you have a PPO plan with UnitedHealthcare, you can see doctors whether they are in-network or out-of-network. It’s important to know that the cost sharing may be higher for an out-of-network doctor. For example with some UHC plans, a primary care doctor visit is a $0 copay in-network, but $25 for an out-of-network doctor. Please understand procedures like surgery or MRI’s may incur a larger and cost prohibitive cost share. We are glad to discuss the costs you may face in accessing out-of-network care with your coverage.
We recommend if you do see an out-of-network St. Joe doctor during this time, please save any records of your statements and bills. It is possible that, if the two sides can come to an agreement, it will be back-dated to July 1st.
How Much Does It Cost to See an Out-Of-Network Doctor?
With a PPO plan, you can see out-of-network doctors, you just may have to pay a little more for your care. In some cases this is minimal. For surgery or MRI’s the difference can be significant. In all cases in an emergency you will be covered as though the provider was in-network, no matter which provider you are taken to. So if you are taken to St. Joseph Hospital in an emergency, you will be treated as normal. Additionally there is no change in cost for urgent care visits, ER visits, and lab work.
Request Continuity of Care
Some patients, including those who are undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. This program allows members to request access to out-of-network doctors but pay in-network prices.
Call the number on the back of your insurance card to see if you qualify.
UnitedHealthcare will provide additional instruction on how to enroll based on your health plan.
Continuity of Care must be requested for EACH doctor you receive care from.
Approval is considered on a case by case basis, and unfortunately is not guaranteed.
Standard approvals can take up to 14 days, and expedited approvals are typically within 72 hours.
If approved you will have continued access for a period of time, typically 90 days.
If you have upcoming care scheduled with a St. Joe doctor, we recommend requesting Continuity of Care immediately. If you have questions about this program we are glad to help advise.
Can I Change My Insurance Coverage?
Unfortunately, most affected Medicare clients cannot make changes to their coverage in the middle of the year. For most clients, we can only review coverage options and make changes during the Medicare Annual Enrollment Period (AEP) and Medicare Open Enrollment Period (OEP);
Medicare Annual Enrollment Period - October 15th through December 7th
Medicare Open Enrollment Period - January 1st through March 31st
Whether UnitedHealthcare and St. Joe come to terms or not, we will be reviewing coverage options for the 880 clients we currently have with UnitedHealthcare. Our job is to find you the best coverage for your needs, period. We are unbiased in which companies we recommend to our clients. Currently companies like Anthem and Humana do have St. Joseph Health and Beacon Health in-network.
Auto-Reassignment of Primary Care Doctor
Some UHC members that have a St. Joe primary care doctor have been auto-reassigned to another in-network primary care doctor. You may receive a new member card in the mail with a different doctors name on it. UHC was required to re-assign you.
If you have a PPO plan you can still see any doctor you choose and do not need to change your primary care provider. You do not have to seek care from the doctors whose name is on your card.
Will St. Joe and UHC Reach a Deal?
At this time both parties are continuing to negotiate. Unfortunately, we are not privy to these discussions. If the two sides can reach an an agreement, they will notify all affected members by letter or other communication. We will also attempt to notify our affected members.
Our sincere hope is that the two parties will reach an agreement for the good of the thousands of people now left in limbo. We encourage our clients to have patience for the time being. If UnitedHealthcare and St. Joe cannot come to an agreement we will help advise a new insurance company to cover all your doctors in the fall.
In the meantime, we are glad to discuss options to ensure your continued access to care. Please call the office, or email your agent directly with any questions. We are glad to help.
For continued updates on the situation, please visit https://www.sjmed.com/uhc