Up and Coming Weekly is a weekly publication in Fayetteville, NC and Fort Bragg, NC area offering local news, views, arts, entertainment and community event and business information.
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8 UCW October 18 - 24, 2023 WWW.UPANDCOMINGWEEKLY.COM I always tell clients: it doesn't matter how good your insurance is on paper if you can't use it. In July, I attended a meeting at Cape Fear Valley Hospital where CEO, Mike Nagowski, and Vice President of Managed Care, Bart Fiser, announced that due to key grievances in service, CFV was terminating the UnitedHealth- Care Medicare Advantage net- work at the hospitals and in 2024 all their other providers as well. Hospitals often have these disputes with insurance carriers. Last year, Duke Wake Med termi- nated their relationship with UHC for about six months. is past February, Charlotte Ears, Nose and roat also an- nounced that they would be terminating UHC unless negotia- tions were made. ere are plenty of examples in North Carolina alone, but the situation at Cape Fear Valley has one major difference than what is typical in these situations: it isn't about money. Mr. Fiser painted a grim scene of doctor frustration and ad- ministrative nightmares, and he claimed that Cape Fear Valley patients were receiving around a 30 percent declination rate of ser- vices with UHC Medicare Advan- tage plans including things like pacemakers. Furthermore, prior approval was being downgraded months later. A diagnosis of sepsis being downgraded to pneumonia because it didn't meet carrier definition was an example I was provided with. Mr. Fiser also explained that transmitting medical records to UHC was particularly vexing because the online portals often won't accept files as large as nec- essary to transmit data. Oftentimes, CFV must mail paper copies costing as much as $800 and increasing the turn- around time on decisions. ese high declination rates, administrative difficulties, and reneging on prior approval have been so detrimental to patient care that the executive team felt forced to cut ties. To quote Mr. Fiser, "I didn't ask for a single penny. We get higher rates with UHC. We were in part- nership with them on shared sav- ings. Denials just got so crazy." On October 5th, I met with Mr. Fiser again to see if there were up- dates that would provide me with insights I can use to better serve my clients. One of my questions centered around PPOs. I had spo- ken with agents and people in the community who had voiced that if they switched to a UHC PPO plan, they would be fine. Mr. Fiser stated they "absolutely would not be fine." While the hos- pital would accept the PPO plans, they would only do so at an out of network rate. I inquired if any headway had been made to repair the relation- ship and was told there had been none, but that "we would cer- tainly listen if they addressed the issues because we want what's best for the community." I point blank asked Mr. Fiser if there was a carrier they did not have issues with and he replied, "we don't have issues with Blue Cross Blue Shield." No others were specifically mentioned. is annual enrollment period, make an informed decision on your plan for 2024 because, to quote Mr. Fiser, "people don't want to drive 75 miles for service." Network nuisance by JOSEPH DOWLESS For effective advertising contact us today! 910•484•6200 OPINION JOSEPH DOWLESS CLC Financial.. COMMENTS? Editor@upandcomingweekly. com. 910-484-6200.