Thousands of pediatric patients could be losing in-network health insurance coverage at one of the Bay area’s premier hospitals for children.
Johns Hopkins All Children's Hospital in St. Petersburg and insurance provider United Healthcare failed to reach an agreement on pre-negotiated rates for patient care.
Health insurance companies negotiate these discounted rates for those covered under their plans.
That’s where the term “in-network” comes from.
Last fall, All Children’s and United began renegotiating their deal. All Children’s asking for compensation closer to the fair market rate. United, of course, trying to keep their costs as low as possible.
Unfortunately, the two companies couldn’t come to a compromise.
And that’s causing big problems for families insured by United.
In a statement, a spokesperson for the insurance company says All Children’s is asking for a 35 percent increase in the compensation the hospital would receive and that all Children’s was using an out of state consultant to negotiate, instead of dealing directly with United, who feels 20 percent would be the fair amount.
Jackson Lemon, 14, looks like an ordinary teen, but he’s been very sick dealing with an autoimmune disorder that’s required four surgeries, numerous procedures, and around 120 days spent living at Johns Hopkins All Children’s Hospital.
"You almost feel like you got sucker-punched there, the wind knocked out of you. At first thinking, what are we going to do," Lemon's mother said. "This is my child’s life basically you’re holding in the balance."
Lemon's parents are insured by United, and now, they’re being told they’ll need to travel to hospitals in Orlando or Gainesville or pay the out of network rate at All Children’s.
"It more than doubles our out of pocket expenses, which is a huge burden that I don’t that our family can afford to do," Lemon's mother said.
Many big employers here in the Bay area have United Healthcare for their insurance including the city of St. Petersburg, Pinellas County Schools, Raymond James Financial and Charter Communications. Several people hoping this all gets sorted out and soon.
All Children's is asking any families impacted by the change to contact their human resources department to ask for another health insurance option where the hospital would be covered in network.