United Health Care Insurance

Local pediatricians not accepting United Health Care

June 2006

I'm getting desperate here and hoping someone out there has better or more information than I do. As anyone with kids and United HealthInsurance probably knows NONE of the local pediatric offices are accepting United after June 22. I've contacted Berkeley Pediatrics, Kiwi Peditrics, Pediatric Mecial group - to name a few and the folks at Pediatric Medical group said they knew of NO pediatricians in the state of California that were going to accept United's contract offer. I've contacted United to find pediatricians but they apparently don't update their lists very often and so tell me doctors are contracted when apparently they are not. I'm at my wits end. We may have the chance to move to Kaiser, but otherwise we're stuck with United and no doc. for my kids. I could give a hoot who my own doc. is, but my relationship with my peditrician so important. We're very lucky and have 2 healthy kids so we don't have an immediate need to see the docotr, but in case something happens - there's no way could pay out-of-pocket. If anyone else is in this situation or has ideas how to deal - I'd love to hear them - now I'm off to put that Universal health care sticker on my bumper America's health system sucks

My son is currently a patient at Berkeley Pediatrics (BP). This was a huge concern for us, too. We just received a letter from BP stating they were able to resolve their contract issues with UHC and their would be no lapse in coverage. I'm not sure about the other places you had mentioned. Good luck in whatever you decide to do. trish

Hi-- we were in a roughly similiar situation to yours, and decided to get our own, private insurance. It was about the same cost as our employer-sponsored insurance, but with a higher deductible. We're willing to live with that, so we can have the doctors we want. We're doing Health Net's Simple Choice 15 and it's been fine.

The only thing that really stinks is that there is NO way to find out how much something will cost before you get it done-- like a bloodtest, x-ray, etc. The insurance company tells you that they promised the provider not to let me know, and the providers tell you that you need to ask the insurance and insist that they're fine with you knowing what it is, but ''can't possibly tell you what exact cost is, since they deal with so many insurance companies''. I learned the hard way that an x-ray at a clinic is several hundred dollars less than one at Children's Hospital ($180 vs $740 for the exact same procedure!). I've even called Barbara Boxer's office about this, but was told there is no law that requires me to be told how much a medical service will cost before it is performed (unlike dry cleaning and haircuts, ugh!) Now that we've been doing this plan for a year, we're learning how to work it, and it's going okay. I've been told it's the same for every company.

I do recommend going to a website like ehealthinsurance.com for an overview of what's out there. However, I strongly recommend speaking with a health insurance broker to actually get your coverage. They can help you through the approval process (mind did it 3x as fast as a website said they could) and also know the ins and outs (for example, my daughter had croup one time, I forgot to put it on the application and the insurance broker helped up from getting denied because of the omission, which was very helpful!!! Our broked was Bill Killips in Walnut Creek (925-906-0630), and I would highly recommend him! He is the kind of guy who would help you find a pediatrician for your current plan, if you decided to stay with it. Regardless, good luck with our very messed up system! -supporter of health care reform

You stated it! I've been dealing with the same issue at my work. Except unlike you I have 3 docs I don't want to sever ties with primary being Paeds, OBGYN and my Neurologist. My choices are 2 fold

1) we cut our association with United through my job and enlist with my Husband's provider (BCBS). They'll accept us under the '' life changing event'' clause.

2) Stay with UH and pay ''out of network'' prices You might want to contemplate asking your work/HR dept if under the ''life changing event'' clause, because of what UH is doing, they can let you sign up with some other option they may carry. This is the best I can offer Equally frustrated

I am a pediatrician and completely understand your frustration with United Healthcare. Basically, they have made us all ''out-of-network'' providers until we negotiate a new contract with them which could take awhile. As I understand it, you do have a couple of options that may help. You can request from United Health Care a ''Continuity of Care'' extension for your kids to stay with their provider if they are under 3 years, or have a chronic condition (who knows which conditions they will consider) and this can get them an extension for 1 year. I would also recommend getting together with your co-workers to talk to your employer. I have heard that some employers are allowing people to switch insurance plans even though it is not their regular open enrollment time as it can be considered a ''major event''- like most will let you switch if you get married or have a baby.

Lastly, as I understand it, if you have to see your doctor, you wouldn't necessarily have to pay completely out-of-pocket, but you would just have to pay a bigger chunk to see an out-of-network provider. Also I'd recommend calling your pediatrician's office- in our office we've dedicated one of the staff to help answer questions and get the right info out to our patients. Hope that helps. Maybe the sunny side is that this will help Universal Health Care! L.

We had the same problem. My approach was to inform my company's HR department of the issue asap to see if they we aware of it and if--since we were locked in to United until open enrollment in January-- they would pick up the additional cost of seeing ''out-of-network'' providers for the remainder of the year.

The HR group contacted UHC, who claimed that our pediatrician's practice would in fact still be covered (through a pre-existing Pacificare contract); I told HR this was incorrect (after confirming with the doctor's office). We went back and forth for some time but the result was that I was given conflicting information from my pediatrician and from UHC (via my HR group).

Ultimately, I asked if my company could open enrollment for me and my family this month and allow me to change providers (as there was another insurance option I could elect) mid-year. They went with that, thankfully.

So my advice is to appeal to your or your partner's HR department and document everything they tell you. I hope you get a constructive response Anon

Primary Pediatrics will stop accepting United HealthCare

June 2006

We have been going to Primary Pediatrics in Oakland for several years and love all the doctors there for our daughter. We received a letter in the mail recently saying they were going to stop accepting United HealthCare PPO due to the recent merger with PacifiCare and they would now be considered ''out of network.'' In talking to the pediatric office they said this is happening with a lot of the offices around Oakland area. We are really upset with this and don't want to compromise our daughters care at all but also don't want to pay a fortune for each doctor visit, esp. when she needs her shots or has a real illness. We are at a loss and don't know what to do (I have United PPO and my husband has PacifiCare, which they won't take now either). Is anyone else having this problem? Any recommendations what to do? DO you know a good pediatric group in Oakland that takes United PPO in case we do have to switch? (Why are health plans compromising good health care??!!) Frustrated mom

There were two posts in this newsletter about medical practices failing to renew their contracts with United Health Care insurance. I'll add my voice to the mix: our wonderful pediatrics practice, East Bay Pediatrics, now also refuses to work with United Health Care. I guess UHC will only reimburse a small fraction of what the doctors used to get paid, so you can't blame them.

As fewer and fewer practices will accept UHC, and more and more patients are ''covered'' by UHC thanks to mergers, then we are simply headed for trouble. Will there be enough good practices to choose from? What if we all switched carriers? What if we all wrote letters of complaint? How many of us are there?

As a practical matter, if you file ''continuation of care'' paperwork with UHC you can at least have your old practice considered in-network. You'll have to make up the difference in cost yourself, but at least you won't have to pay for the whole thing Nicole