Charlotte moms still face high epidural costs as healthcare dispute continues

Why it matters: For over a year Providence Anesthesiology Associates has been out of UnitedHealthcare’s network thanks to failed contract negotiations. As a result, new moms — as well as other UHC patients receiving anesthesia at Novant — are no longer covered for those services. [Go deeper]

Flashback: PAA is the exclusive anesthesiology provider for Novant Health, one of Charlotte’s largest healthcare networks. And UHC insures over a million North Carolinians.

• The negotiations haven’t advanced since we first reported on the contract dispute in September.
• Both parties, UHC and PAA, still blame the other for the out-of-network change, and ask the other party to compromise in negotiations.

Of note: Out-of-network bills were anywhere from $4,000 to $14,000, according to patients we’ve spoke to. Fortunately, most patients aren’t stuck paying the full amount. PAA says less than 5% of patients pay anything at all, but the process to negotiate the bill can be long and arduous.

Novant and PAA have put in systems to notify impacted patients ahead of time. Still some patients tell me they’re still learning about PAA’s out-of-network status through our reporting.

“I changed my birth plan because I didn’t want to get a surprise bill,” Julia Barno, who gave birth to her second child in December, tells me.

“I shouldn’t have even been in that position to begin with,” she says. “I spent so much of the rest of my pregnancy mentally preparing myself for all this pain. I prepared my husband to basically be a dula.”

Barno could’ve gone to another healthcare system where epidural services are covered by UHC. But after forming a relationship with her doctor, she didn’t want to move.

• Ultimately Barno wasn’t able to go through with her new birth plan and had to get an epidural. Now, she dreads checking the mail as she awaits her out-of-network bill from UHC. “It’s just one blow after another,” Barno says of waiting for the bill during a pandemic after losing her job last year.

What to watch: UHC is in contract disputes with other healthcare providers around the country. In one instance lawmakers urged UHC to settle a dispute that impacted 60,000 Bronx-area patients.

What they say: Each of the three parties involved sent statements regarding the dispute between PAA and UHC.

A UHC spokespersons says: “Exorbitant surprise bills are stressful for patients and drive up the cost of health care for everyone. That’s why Congress passed legislation that will prohibit providers from surprise billing their patients starting in 2022. What’s most important for our members to know is that they should contact us if they receive a surprise bill from Providence. We will work directly with Providence to negotiate a reimbursement rate so our members are not held responsible for paying the bill.”

PAA sent a statement saying: “United HealthCare customers should not be alarmed by costly out-of-network bills, which we are required to send according to North Carolina law. We are working hard to minimize the financial impact of United’s actions by filing appeals with United and claims with the North Carolina Department of Insurance, which has consistently sided with Providence by compelling United to cover patients at close to in-network rates. It should be noted that no Providence patients have been sent to collections and fewer than 5% have paid anything toward their bill, with an average payment of less than $100. We continue to push for rejoining United’s provider network while our physicians, often at great personal risk and sacrifice, go on serving patients without regard to their ability to pay.

A Novant spokesperson says: “Novant Health is working to ensure our impacted patients are notified of the changes prior to a procedure as best we can. We understand Providence Anesthesiology Associates is also doing what it can to ensure patients are not burdened with higher-than-expected charges for their services.

Unfortunately, the impasse in negotiations between UHC and PAA has our patients stuck in the middle. UHC must resume negotiations, now, and work with PAA to find a reasonable solution. We continue to share our patients’ concerns and frustrations.

Under all circumstances, it’s imperative patients feel empowered to confirm with their insurance provider what is in-network by facility – and also by physician. We have a team of financial navigators who are available to help patients better understand their anticipated health care expenses, including what questions to ask of their insurance provider prior to a procedure.”

If a patient has received a bill from PAA, or an estimate of charges from UHC, they should call PAA prior to making a payment at 704-749-5801. This will ensure any and all options to reduce their bill are exhausted.