A Medicare Advantage health insurance plan that connects Floridians living with HIV/AIDS to medical services is breaking its contract with Broward Health amid complaints that the hospital system is seeking “unacceptable” cost increases for in-network services.
Administered by the nonprofit AIDS Healthcare Foundation, the Positive Healthcare Partners (PHP) plan serves 1,425 members in Broward, Miami-Dade and Duval counties. Of these, 843 are in Broward County.
Unless a new contract is signed, members will lose access after May 31 to all Broward Health hospitals, including Broward General Medical Center, Broward Health North, Imperial Point, and Broward Coral Springs. They will lose access to primary care physicians and Broward Health Physician Group specialists after Aug. 10, foundation officials said.
The plan is open to people who are eligible for Social Security disability insurance and become eligible for Medicare Part A and Part B after a 24-month waiting period. In South Florida, Broward Health has served its members under a contract in place since 2008, according to a press release from the foundation.
PHP admins say Broward Health’s prices have gone up every year to the point that they can no longer afford them. When the foundation requested a new contract, Broward Health offered a new cost structure that provided no relief, they said.
Broward Health disputed the foundation’s statement about its offer, saying through a spokesperson, “We presented Positive Healthcare Partners (PHP) with a proposal at no cost increase – a rate on which PHP agreed over the past seven years – despite unprecedented inflation and skyrocketing costs. associated with the pandemic. PHP’s response was to terminate Broward Health.
Donna Stidham, head of managed care for the AIDS Healthcare Foundation, said that while the foundation has been paying the same percentage of Broward Health’s prices for several years, those prices increase each year and with them the amount billed to the foundation.
“About a year and a half to two years ago, we went to Broward Health and said, ‘We need a new rate. The rates you charge us are prohibitive. We can’t afford it anymore. We want a contract that’s a percentage of Medicare [reimbursement].'”
Ultimately, she said, Broward Health submitted a proposal that would have required the foundation to pay, on average, 80% more than Medicare pays for services. For some patients hospitalized for long periods of time, these costs would exceed Medicare reimbursement rates by 200%.
In a press release on the dispute, Stidham said: “It is appalling and unacceptable that Broward Health, a public health system, wants to continue to operate a not-for-profit insurance plan that has provided health care services for more than three decades. life-saving services to those living with HIV.
“Given the continued increase in the number of people diagnosed with and living with HIV and other health conditions, we all need to work together to ensure that nothing stands in the way of anyone having access to care and possibly falling out of care, especially publicly funded hospitals like Broward Health.”
The cost impacts for members would be negligible if the contract were to expire, said Karen Haughey, registered nurse and vice president of managed care at the AIDS Healthcare Foundation. This is because the foundation offers its Medicare Advantage plan at zero cost to members and strives to cover all costs for all medical care, transportation, medications, and procedures.
Trustees say they fear members will be frustrated by the prospect of having to find new doctors and stop seeking care. For many members, it took years to build relationships and trust with their doctors, they say.
Foundation spokesperson Imara Canady said people living with HIV/AIDS “are one of the most vulnerable populations we serve. We know there is a strong possibility that even a change or failure to go to care providers they trust could lead them out of care.
On the east side of Broward County, where many plan members reside, the loss of Broward General and Imperial Point would leave only Holy Cross Hospital on the North Federal Highway in Fort Lauderdale easily accessible, according to the provider directory of the plan.
Negotiations are underway to enter into separate contracts with Broward Health Physician Group providers and to add more hospitals to the plan’s provider network, Haughey said.
Claude Lampkin, a Fort Lauderdale resident and plan member, said he was seeing a primary care physician and specialists for foot, eye and back problems. He is afraid of losing them, he says. “What will happen after that? He asked. “Better care? I have no idea.”
Cliff Eserman, a Wilton Manors-based health insurance broker, said people living with HIV/AIDS may find it “disheartening” to lose a long-time provider and have to seek out a new one sensitive to the challenges of their treatment. . “It’s exhausting to start over,” he said. “And it’s hard to let go of a supplier you’ve been with for a decade.”
In its statement, Broward Health said its commitment to serving people living with HIV/AIDS will not waver. “To the HIV community, Broward Health has always taken great pride in caring for you, as evidenced by the work we do through our Ryan White grant and many other programs,” the statement read. “We will continue to be here for you despite PHP’s actions.”
The dispute between the foundation and Broward Health came to light a week after UnitedHealthcare, one of the nation’s largest health insurers, terminated its contract with Broward Health, cutting network access to thousands of its members. of South Florida, including those of insurers. self-funded employer groups, individual plans, and Medicaid plans.
No resolution to that dispute has been reached, a UnitedHealthcare spokesperson said Thursday.
Ron Hurtibise covers business and consumer issues for the South Florida Sun Sentinel. He can be reached by phone at 954-356-4071, on Twitter @ronhurtibise or by email at firstname.lastname@example.org.