You probably don’t recognize the name Rick May. But, on Capitol Hill in Denver, he is a household name to legislators involved in the health care debate. As President of the Colorado Medical Society, he is the voice of Colorado’s doctors. Right now, that voice is telling us that a crisis is right around the corner and that Insurance Commissioner David Rivera is asleep at the switch.
HCA, Inc., one of the largest hospital and clinic operators in metropolitian Denver and United Healthcare, one of the biggest health insurers in the state (which recently gobbled up PacifiCare, one of its main competitors, in a merger) don’t have a deal. If they don’t get one by Friday, chaos will ensue.
Here are some excerpts of May’s letter to Colorado’s insurance commissioner:
Commissioner Rivera, it’s time for an intervention in the sumo-wrestling match between two of the big gorillas in the Denver health care arena. . . . If they can’t settle their differences, their failure is far more than a business deal gone bad. . . . we will likely see our patients scattered across four counties, forced to wait weeks or months for treatment . . . . Patients will be utterly confused by all this and will inevitably hestitate to seek hospital services or end up paying out-of-network prices (potentially 100% of hospital charges) because they need care fast. . . . We need you to blow a whistle, throw a flag, and throw a fit. Invoke your moral and legal authority to short-circuit their game of chicken. The “free market” you talk about isn’t so free when two of the 800-pound gorillas that have come to dominant our health care system start limiting choices. . . . the 30-day trigger has been pulled to notify physicians nad patients of the impending collision and its real world, real time consequences, the cold reality should be setting in. . . . Knock some sense into them before its too late.
According to the Denver Post, as of the end of last week:
Linda Kanamine, a spokeswoman for HCA [said] “We are still far apart.”
The disputes largely involve reimbursement rate increases from the insurance company to HCA, the health care provider.
Rivera apparently doesn’t agree with Rick May. According to the Denver Post:
Rivera said the insurance division has reviewed United’s so-called “access plan,” which intends to ensure adequate patient care if a contract extension can’t be reached.
“We are comfortable with the plan United has put forward,” he said.
The Insurance Commission FAQ on the situation notes that emergency care will still be covered as “in network” and that no one currently in the hospital will be charged “out of network” rates before they are dischaged, while others may continue to receive “continuity of care” exceptions for their treatment.
But, the Rivera fails to note in the Insurance Commission FAQ that non-emergency care will be dramatically different next week if there is no deal.