HIV/AIDS Health Insurance Plan Says Broward Health Seeking 'appalling' Rate Hikes [South Florida Sun-Sentinel] – InsuranceNewsNet - Insurance News Net

A Medicare Advantage health insurance plan that connects Floridians living with HIV/AIDS with medical services is severing its contract with Broward Health amid complaints that the hospital system is seeking “unacceptable” cost increases for in-network services.

Run by the non-profit AIDS Healthcare Foundation, the Positive Healthcare Partners (PHP) plan serves 1,425 members in Broward, Miami-Dade and Duval counties. Of those, 843 are in Broward County.

Unless a new contract is signed, members will lose access after May 31 to all of Broward Health’s hospitals, including Broward General Medical Center, Broward Health North, Imperial Point and Broward Coral Springs. They will lose access to primary care doctors and specialists within the Broward Health Physician Group after Aug. 10, foundation officials said.

The plan is open to persons who qualify 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 members under a contract in place since 2008, according to a foundation news release.

PHP administrators say Broward Health’s prices have been increasing each year to the point they can no longer afford them. When the foundation sought a new contract, Broward Health proposed a new cost structure that provided no relief, they said.

Broward Health disputed the foundation’s statement about its offer, saying through a spokeswoman, “We presented Positive Healthcare Partners (PHP) a proposal with no cost increases — a rate that PHP has agreed upon for the past seven years — despite unprecedented inflation and skyrocketing costs associated with the pandemic. PHP’s response was to terminate Broward Health.”

Donna Stidham, chief 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 have increased each year and along with it, the amount charged 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’re charging us are prohibitive. We can no longer afford it. 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 that what Medicare pays for services. For some patients with long hospital stays, those costs would exceed Medicare’s reimbursement rates by 200%

In a news release about the dispute, Stidham said, “It is appalling and unacceptable that Broward Health, a public health system, wants to continue to gouge a non-profit insurance plan that has over three decades of providing life-saving services to those living with HIV.

“Given the continued increase in the number of individuals diagnosed and living with HIV and other health challenges, we need to all be working together to ensure nothing inhibits anyone from having access to care and possibly falling out of care, especially publicly funded hospitals like Broward Health.”

Cost impacts on members would be negligible if the contract is allowed to expire, said Karen Haughey, a registered nurse and vice president of managed care at the AIDS Healthcare Foundation. That’s because the foundation provides its Medicare Advantage plan at zero cost to members and strives to cover all costs for all medical care, transportation, drugs and procedures.

Administrators say they are worried that members could become frustrated by the prospect of having to find new physicians and stop seeking care. For many members, it has taken years to build relationships and trust with their physicians, they say.

Foundation spokesman Imara Canady said people living with HIV/AIDS “are one of the most vulnerable populations we serve. We know there’s a strong possibility that even a shift or lapse in going to providers they trust for care could lead to them falling out of care.”

On the east side of Broward County, where many of the plan’s members reside, loss of Broward General and Imperial Point would leave only Holy Cross Hospital on North Federal Highway in Fort Lauderdale within easy access, according to the plan’s provider directory.

Negotiations are underway to forge 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 sees a primary care physician, and specialists for problems with his feet, eyes and back. He worries about losing them, he said. “What’s going to go on after this?” he asked. “Better care? I have no idea.”

Cliff Eserman, a Wilton Manors-based health insurance broker, said people living with HIV/AIDS can find it “disheartening” to lose a longtime provider and have to look for a new one sensitive to their treatment challenges. “It’s exhausting to start over,” he said. “And it’s hard to give up a provider you have been with for a decade.”

In its statement, Broward Health said its commitment to serve 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 accomplish through our Ryan White grant and numerous other programs,” the statement said. “We will continue to be here for you despite the actions of PHP.”

The dispute between the foundation and Broward Health comes to light a week after UnitedHealthcare, one of the nation’s largest health insurer, terminated its contract with Broward Health, severing in-network access to thousands of its South Florida members, including those in the insurers’ self-funded employer group, individual plans, and Medicaid plans.

No resolution of that dispute has been reached, a UnitedHealthcare spokesman 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 [email protected].