UMass will cut ties with UniCare; 6,000 encouraged to choose another plan.
WORCESTER -- UMass Memorial Health Care has notified about 6,000 state employees and retirees that it will no longer accept their UniCare State Indemnity health care plans after July 1 -- and no longer allow them to schedule appointments with UMass Memorial affiliated doctors.
According to the letter, "two years of difficult negotiations'' have not led to a new agreement between UMass Memorial and UniCare.
As a result, UMass Memorial will stop scheduling patients covered by UniCare in elective surgeries on or after July 1, according to the letter, which was mailed to the affected employees and signed by Dr. Stephen Tosi, chief physician executive at UMass Memorial.
The letter encourages employees who receive their health care coverage through UniCare plan, which is administered by the state's Group Insurance Commission, to choose other plans available through the GIC. Those plans include the Fallon Health Select Plan, the Harvard Pilgrim Independence Plan, the Health New England HMO and the Tufts Health Plan Navigator. Switching to any one of those plans would allow the employees to continue seeing UMass primary care physicians. The UniCare patients can choose one of those four plans, or the Neighborhood Health Plan NHP Plan, if they want to visit specialists at UMass Memorial.
"If you decide to keep your coverage through UniCare, you will need to seek care from non-UMass Memorial providers, effective July 1,'' Dr. Tosi wrote. Exceptions will be made for patients with terminal illnesses, parents in their second or third trimester of pregnancy, and those requiring emergency services. Those patients "shall continue to be covered at UMass Memorial, as required by law,'' the letter stated.
Dolores Mitchell, executive director of the Group Insurance Commission, said the issue comes down to money. UMass has proposed one rate, and UniCare has proposed another, lower rate. The two sides cannot come to terms, and their contract expires on July 1.
"It's not like we would not agree to any increase in the rates,'' she said. "They (UMass Memorial) have been threatening this for a long time.''
The GIC and its agent, UniCare, "have agreed that what they are asking for is excessive,'' she said. Ms. Mitchell added that UMass Memorial pulled the plug on negotiations.
There still may be options for employees covered by UniCare, Ms. Mitchell said.
Under the an indemnity plan, employees covered under UniCare -- which include current state employees, some municipal employees covered under the Group Insurance Commission plan, and state retirees -- can still go to their UMass Memorial doctor. If an invoice is created, it can be submitted to UniCare, and paid as usual, she said. Co-pays and other expenses currently charged to UniCare patients would remain the same, she said.
"It's really up to the individual doctors, what they choose to do,'' she said.
The question is whether UMass Memorial will continue to allow UniCare-covered employees to set up appointments with UMass Memorial-affiliated doctors. The letter from Dr. Tosi indicated that UMass Memorial will not.
"It is... awfully close to unprofessional conduct,'' Ms. Mitchell said. "It is tantamount to patient abandonment. I have made my position clear, and I think its (UMass Memorial) move is highly inappropriate.''
UMass Memorial spokesman Tony Berry said in a statement:
"The decision to terminate the relationship with UniCare was not made lightly, but after nearly two years of good faith negotiations. We sincerely regret the inconvenience caused to our patients, whose well-being is our primary concern.''
Tufts Health Plan and UMass Memorial engaged in a similar battle over health care rates, which was only settled hours before a Jan. 1, 2015 deadline. Had the negotiations failed, patients covered under Tufts would not have been able to schedule appointments at any UMass Memorial Health Care facility or with a UMass Memorial-affiliated doctor.
Aaron Nicodemus can be reached at email@example.com. Follow him on Twitter at @anic89.