Lack of contractual enforcement affecting health care for many


Most New Jersey residents are concerned about various factors of health care, such as the cost and quality of physicians. So, they may be able to relate to a situation where these factors are being affected by a contract dispute between a health insurance company and a hospital system in another state. The lack of contractual enforcement revolves around money.

A company called BayCare operates 11 hospitals, ambulatory centers and more than 300 physicians. BayCare is claiming that UnitedHealthcare does not adequately pay the hospital for treatment. UnitedHealthcare allegedly owes BayCare $11 million, while UnitedHealthcare is disputing the high service fees charged by BayCare. Now that BayCare is seeking a 22 percent increase, UnitedHealthcare claims that this is much more than other hospitals in the area.

The contract expired on November 26, leaving many patients insured by UnitedHealthcare having to pay much more for medical treatment now that their once in-network physicians are considered out-of-network. This contract dispute affects 456,000 patients. Some doctors are now refusing to see UnitedHealthcare customers altogether. Many patients have pre-existing conditions, which makes it difficult and even impossible to find new health care coverage elsewhere.

Many customers were aware of the expiring contract and scheduled major procedures before then. However, many who have future surgeries scheduled are worrying about how they will be able to afford it if there is no contract between UnitedHealthcare and BayCare.

Almost every business will be party to a contract at some point. A contract can be an agreement between the company and the customer, or between two companies. It lists obligations expected by either or both parties and must be mutually agreed upon and signed. A written contract is legally enforceable. If either party fails to live up to their end of the contract, state laws will enforce it. It is extremely important for any company contemplating a contract agreement to be sure to get all of the right information prior to signing.

Source: The Tampa Tribune, "UnitedHealthcare, BayCare dispute puts patients in the middle," Mary Shedden, Nov. 29, 2012