Why is this happening?
Your child’s health care is our highest priority. Johns Hopkins All Children’s Hospital is unwavering in its support and care for the children of our region and beyond. We hope this page will answer any concerns you may have because of news or information you have received about a contract negotiation between United Healthcare and Johns Hopkins All Children’s Hospital.
Johns Hopkins All Children’s is a not-for-profit hospital whose sole focus is to provide the highest quality and safest care for children. All we do is all for kids. Our treatment, research and teaching are totally focused on improving care, developing better therapies, finding cures and educating the next generation of pediatric specialists. Investments in people and technology are paramount to this mission.
Updating rates insurance companies, such as United Healthcare, pay for services every few years is standard practice. It is unfortunate that in our first contract renegotiation in over five years with United we have been unable to reach a new agreement. We are asking United to pay a rate in line with what other insurance providers pay so that we can focus on our number one priority – taking care of kids.
As of May 11, 2017, United Healthcare will consider hospital-based services and provider (physician) services at Johns Hopkins All Children’s Hospital as out-of-network.
There are many different plans offered by United Healthcare. Some plans have higher deductibles and/or copay for out-of-network services. Other plans do not provide any coverage for out-of-network services. We recommend that you look at your health plan description of benefits or call United to determine how out-of-network services are handled on your particular plan. If the insurance is provided through an employer, you can also talk to their benefits department.
How this can impact you
How does this affect your emergency center visit?
Based on law, your insurance company must process your Emergency Center treatment as an in-network benefit. They are not allowed to assign patients higher coinsurance or copays for emergency services.
By law we may not and will not charge you more because of our contract status. This means we will not bill you for the difference between our charges and what United pays us for your visit. If you have any questions regarding your bill please call us at 727-767-8284 or 1-800-767-8284.
However, if you are placed in an observation or inpatient status, your treatment will be considered out-of-network. This means you will have higher out-of-pocket responsibilities. Your insurance may also require you to be transferred to an in-network facility.
If you or your child is already an inpatient at Johns Hopkins All Children’s Hospital on May 11, 2017:
The hospital stay and physician services will be covered as in-network for up to 6 months until you are discharged or it is determined that you can be safely discharged to another facility.
If you or your child is in active treatment for a chronic or acute health condition as of May 11, 2017:
If you come to Johns Hospital All Children’s Hospital or a Johns Hopkins Outpatient Care facility for doctor visits or outpatient service visits, the visits for this condition will be in-network for up to 6 months.
If you are a pregnant woman receiving care from an All Children’s Specialty Physicians OB-GYN or maternal-fetal medicine specialist:
You will be covered as in-network through the end of your pregnancy and post-partum care. This also applies to pregnant women who are expecting a child known to have a heart defect or congenital diaphragmatic hernia.
If you or your child is done with treatment and then needs our services in the future:
At that time our scheduling team will be happy to have a discussion about your coverage options, including our financial assistance policy.
If you or your child is scheduled for a new appointment as a new patient after May 11, 2017:
United Healthcare will consider the visit as an out-of-network service. You may call United to discuss the coverage options available to you under your plan.
If one of our physicians is treating your child as an inpatient at an affiliate community hospital where they have medical staff privileges:
The physician services for your child's care will be covered as in-network for the duration of the inpatient stay.
Answers to more questions
Why did I get a letter from Johns Hopkins All Children's Hospital regarding my United Healthcare insurance?
It’s normal business practice for hospitals and health insurers to renew/renegotiate their contracts every few years. We’ve been working on this with United Healthcare for many months and, unfortunately, have not been able to reach a new agreement. We will continue to reach out to United in hope of finding a solution.
What will I owe for my visit if it is considered out-of-network?
We do not want our patients and families to be overwhelmed with this or to be concerned that they will receive a “surprise bill” from us after services are rendered. Therefore, we are providing families with estimates of their financial responsibility given this change with United. We will honor our estimate and will not bill for amounts above any estimate you receive. Please call us at 727-767-7016 or request an estimate online, our centralized patient estimation unit can help you.
What providers are in my network that you would recommend?
We encourage you to call United Healthcare to explain your child’s needs and ask them to provide a list of in-network providers.
If there’s no in-network provider available, we’ll help you understand your options and we can talk to your insurance company about getting authorization for treatment here as “out-of-network.”
I want to keep coming to Johns Hopkins All Children's Hospital for my/my child’s care. What can I do?
If your plan includes coverage for out-of-network services, you can choose to pay the out-of-network deductible and co-pay and continue your care here.
You can also choose to use our services and apply for financial assistance or a self-pay discount.
Can I change my health insurance or my child’s health insurance?
If you have a choice of plans, you can usually change only during the "open enrollment" period unless you have a qualifying event such as a birth, marriage, divorce or change of employment.
You will need to contact your employer or insurance broker to discuss these options.
Who can I contact with concerns about my or my child’s coverage?
We urge you to reach out to United Healthcare at the number on the back of your insurance card to share your concerns.
If your health insurance is provided by your employer, we encourage you to include the employer in your discussions.
If you have more questions
You should call United Healthcare at the number on the back of your insurance card to get specific information about out-of-network coverage under your policy. In addition, we are happy to answer your questions and discuss concerns about coverage for services at Johns Hopkins All Children’s Hospital.
We are happy to answer your questions and discuss concerns. We have set up a special telephone line for these calls: 727-767-8284 or 1-800-456-4543, ext. 78284. Please call between 8:00 a.m. and 6:00 p.m. Monday through Friday or between 10:00 a.m. and 4:00 p.m. on Saturday to speak with one of our staff members. If you get voicemail, leave a message with your daytime contact information and we will return your call the next business day.
How you can help
Your voice matters. We urge you to contact United Healthcare at the number listed on the back of your insurance card to discuss your concerns and the impact that this is having on you and your family.