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Hospital offers discount after Southeast Missouri State University changes health plan

Friday, November 12, 2010

(Photo)
Southeast Missouri State University's Academic Hall.
(Fred Lynch)
EDITOR'S NOTE: Due to a source error, Saint Francis was described as a Level II trauma center. The hospital is actually a Level III center.

Saint Francis Medical Center will offer a special payment option for Southeast Missouri State University employees who choose to be treated at the hospital.

Under a new insurance plan approved by the Southeast Missouri State University Board of Regents last month, Saint Francis is now an out-of-network provider, which means Southeast's 1,100 faculty and staff members and their families would have to pay more out of pocket to receive care there.

Saint Francis has received many inquiries from university employees who want to know what they need to do if they want to continue to come to the facility.

"Saint Francis Medical Center looks forward to continuing to provide quality care to Southeast Missouri State University employees or any other employees covered by United Healthcare plans," said Tony A. Balsano, vice president of finance. "We want to reassure patients of access to Saint Francis without any out-of-network financial penalties, if they satisfy the requirements of the prompt pay discount."

The discount agreement is offered to patients who agree to pay copays and deductible amounts within 45 days of getting their hospital bills.

The prompt pay discount reduces the patient's copay and deductible to amounts comparable to what they would pay at an in-network hospital, Balsano said. It's available for all insurance plans that consider Saint Francis out-of-network, including United Healthcare, which Southeast Regents awarded the university's 2011 medical insurance package, a move that will save about $1.1 million. Their previous insurance provider, Anthem Blue Cross and Blue Shield, included both Southeast Hospital and Saint Francis Medical Center as in-network providers.

Under federal health care reform legislation passed earlier this year, policies issued by insurance companies after March 2010 must cover emergency services at an in-network provider rate regardless of whether the service is provided by an in- or out-of-network facility. There are some exceptions, depending on when individual plan years start.

Saint Francis' Gene E. Huckstep Emergency and Trauma Center is the region's only state-designated Level III trauma center, caring for the most serious injuries occurring between St. Louis and Memphis. It is required by law to treat anyone, regardless of their ability to pay.

Health care reform measures also prohibit insurance companies from requiring preapproval of emergency services.

United Healthcare did not respond to requests for comment.

For more information about eligibility for the discount program, call 331-5182.

mmiller@semissourian.com

388-3646

Pertinent address:

211 Saint Francis Drive, Cape Girardeau, M-


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Eastony, if you are going to continue to spam these threads with this post at least proofread it.

-- Posted by Longstroker on Fri, Nov 12, 2010, at 7:25 AM

First of all, I have had UHC insurance for 2 years and so have my co-workers. Saint Francis never offered us any kind of "discount" so that we could use their hospital. In my opinion, Saint Francis is only worried about their pocketbook and that is why they are not in the UHC Network. So now all of a sudden the SEMO employees aren't going to be able to use their hospital and they are now worried about losing business. So they offer them a discount...why not the rest of us?

-- Posted by Elphaba on Fri, Nov 12, 2010, at 9:18 AM

First of all, I have had UHC insurance for 2 years and so have my co-workers. Saint Francis never offered us any kind of "discount" so that we could use their hospital. In my opinion, Saint Francis is only worried about their pocketbook and that is why they are not in the UHC Network. So now all of a sudden the SEMO employees aren't going to be able to use their hospital and they are now worried about losing business. So they offer them a discount...why not the rest of us?

-- Posted by Elphaba on Fri, Nov 12, 2010, at 9:19 AM
Response by Melissa Miller:
According to a statement from Saint Francis, the prompt pay discount is available for any health plans that consider Saint Francis out of network. You should contact the hospital directly to see if you qualify.

From the website: The Gene E. Huckstep Emergency Center/Level III Trauma Center at Saint Francis Medical Center is the region's only state-designated Level III Trauma Center.

Article here says it is a level II center. Can you find out where the confusion is? There is quite a difference as level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries, Example: Rural or Community hospitals.[

-- Posted by Beaker on Fri, Nov 12, 2010, at 9:29 AM
Response by Melissa Miller:
The hospital is a level III trauma center. The first version of this article stated the trauma designation incorrectly.

If they're going to offer this "discount", why don't they just join the network?

And most hospitals make no mention of these discounts when they send their bills, so you don't even know if there is a discount or how much it is. I learned this after paying a full bill from another hospital, then learned they offered a discount. When I called them about it, they said they would refund my overpayment, but it wasn't automatic and they would not have even looked at it if I had not called to inquire.

-- Posted by WorkerB on Fri, Nov 12, 2010, at 9:30 AM

St. Francis is listed as a Level III Trauma Center on missouriems.com. There are no Level I or Level II trauma centers outside of MO's major metropolitan areas.

-- Posted by Beaker on Fri, Nov 12, 2010, at 9:36 AM

"Under federal health care reform legislation passed earlier this year, policies issued by insurance companies after March 2010 must cover emergency services at an in-network provider rate regardless of whether the service is provided by an in- or out-of-network facility. "

Of course this mandate does not require that the hospital charge a reasonable out of network rate. We are told by providers that they must extort money from those who pay to cover those who don't pay. What kind of oversight is there on these not-for -profit organizations that can pretty well just pick a number out of thin air and charge the customer? Emergency care is an immediate need and one cannot price shop for the most reasonable facility when the service is needed.

We were told that we must pass the bill to find out what's in it. The problem is that this bill was all about insurance and did not address the real problem which is the PRICE of HEALTH CARE, not the cost of insurance.

-- Posted by yy4me on Fri, Nov 12, 2010, at 9:55 AM

folks, folks: if you haven't figured this out by now, where have you been? this is all based on MONEY. sfmc does not want to lose the business from the employees of the university. or at least the ones who come to sfmc. yes, i agree, what about a discount to all the other people not working at the university? we just pay the full amount.

nuff said, have a great day

-- Posted by Next Candidate for Mayor on Fri, Nov 12, 2010, at 9:55 AM

SFMC provides wonderful health care and yet HORRIBLE overcharging if they can get away with it. It's almost criminal if you ask me. They take extra money each and every time we have used them, and it amounts to one hassle after another to try to settle a bill. No one wants to get sick and need emergency care, and I have a terrible feeling every time we are in need of their services because I know I'm in for a fight on the other end when the bill comes. This has to stop! They build these wonderful facilities with all the extra they steal from those who can afford to pay.

-- Posted by sayswho? on Fri, Nov 12, 2010, at 10:17 AM

If we had a single-payer system like the rest of the so-called civilized world, we wouldn't need discounts.

-- Posted by redpen on Fri, Nov 12, 2010, at 10:22 AM

I don't understand why they won't join United Healthcare's directory either? SFMC should be concerned enough about their patients to work with the employer's insurance company. I just don't get it.

-- Posted by sixteen on Fri, Nov 12, 2010, at 10:28 AM

As of January 1st, they will no longer hire people who smoke. A little off topic but just an FYI.

-- Posted by nObama on Fri, Nov 12, 2010, at 10:49 AM

"provide quality care to Southeast Missouri State University employees or any other employees covered by United Healthcare plans"

"It's available for all insurance plans that consider Saint Francis out-of-network,"

Next Candidate for Mayor and Elphaba -- what part of that statement do you not understand? This isn't just for Semo employees, it's for ANY person that has United.

-- Posted by gomer on Fri, Nov 12, 2010, at 11:13 AM

St Francis, I agree if your going to offer a "discount" why not just be in the network? You say you will give a discount if paid within 45 days? Your notorious for having the bill in the mailbox when we arrive home from the hospital already and if not paid in a month you turn us over to a collection agency!!! It is all about the $ and no thanks we can go to another hospital in the network!!!!

-- Posted by in the money on Fri, Nov 12, 2010, at 11:19 AM

"Saint Francis Medical Center looks forward to continuing to provide quality care to Southeast Missouri State University employees or any other employees covered by United Healthcare plans," said Tony A. Balsano, vice president of finance. "We want to reassure patients of access to Saint Francis without any out-of-network financial penalties, if they satisfy the requirements of the prompt pay discount."

It appears they do offer the same benefit to anyone who is out of network. and BTW though I do not know the in and outs of this I do know that some insurance companies limit the number of providers in an area. Hence with a decrease in providers it is a decrease in access thus limiting the cost to the insurance company. Instead of complaining about St. Francis why is the insurance company not willing to put St. Francis in their "in-network" provider list?

-- Posted by SWBG on Fri, Nov 12, 2010, at 11:19 AM

To SWBG: like Elphaba, I have had UHC insurance for 2 years, too. I was told by my company that SFMC is the one who won't sign with UHC. Not the other way around.

-- Posted by sixteen on Fri, Nov 12, 2010, at 11:29 AM

SWBG you are exactly right! United Health Care will not give St Francis Medical Center a contract similar to the one they gave Southeast Missouri Hospital. It is the insurance company who controls this and it is all about the money in United Health Care's pocket. St. Francis is willing to take the cut to provide Southeast Missouri State University employees and any other employees the option of going to either hospital. I personally think this is a great move on their part considering the doctor I go to is at St. Francis Medical Center.

-- Posted by coolcat on Fri, Nov 12, 2010, at 11:38 AM

coolcat, FYI your doctor would be given privileges at both hospitals unless, of couse, he or she has done something that would necessitate a hospital removing that doctor's right to practice at the particular hospital.

-- Posted by sayswho? on Fri, Nov 12, 2010, at 12:01 PM

I have been reading these comments with interest. I work in the healthcare industry and its common knowledge that UHC has been trying to get a contract with Saint Francis for a long time now. This is a small town here and not much is a secret.

To coolcat - its not that UHC won't give St Francis a contract, but St Francis won't even look at what UHC is offering. Insurance companies don't control much in Cape, that's for sure. Just look at the history of healthcare in this town.

-- Posted by healthfirst on Fri, Nov 12, 2010, at 1:10 PM

sayswho?, my doctor is an employee of St. Francis Medical Center.

-- Posted by coolcat on Fri, Nov 12, 2010, at 1:12 PM

healthfirst, do you work at St. Francis Medical Center? Is that how you know so much?

-- Posted by coolcat on Fri, Nov 12, 2010, at 1:13 PM

Just as I thought. If you read my post again it says that United Health Care will not offer St. Francis Medical Center a similar contract.

-- Posted by coolcat on Fri, Nov 12, 2010, at 1:32 PM

I work in the healthcare field too and NO it is not at St. Francis. I have UHC as my insurance and I really hate that we have St. Francis as our customer and not Southeast but we cannot use St. Francis without paying out of network charges. We tried to work with UHC on this issue but they did not budge. UHC is horrible about paying off any claims until they are just about in collection. I can understand why St. Francis would not want to deal with them. That being said, I suspect that St. Francis was not willing to put up with the long waits on payment and UHC is notorious for making only one really good deal with a hospital and making the others secondary with a lower reimbursement rate.

-- Posted by jcwill on Fri, Nov 12, 2010, at 1:43 PM

I have been told that it is Saint Francis that will not consider accepting a contract from UHC. Bottom line is this: Saint Francis is only concerned about the bottom line, not the patients. That is why they have SUDDENLY decided to offer this "discount" to SEMO employees and others with UHC because there are a lot of SEMO employees who have used SF over the years. They have not been concerned about the rest of us "peons" because there wasn't enough of us to make any real difference in their pocketbook. That's all there is to it. Period!

-- Posted by Elphaba on Fri, Nov 12, 2010, at 1:49 PM

Doesn't P&G use United also? If two of the largest employers in the area both utilize UHC, seems like any medical provider in this area would want to be in their network. Seems like it would be sound business for them to do so.

-- Posted by PatK on Fri, Nov 12, 2010, at 2:33 PM

Like I said before, St. Francis will not consider the contract that United Health Care offered them because it was WAY below the reimbursement they offered Southeast Hospital. Would you take half the pay your co-worker got for doing the same job????

-- Posted by coolcat on Fri, Nov 12, 2010, at 3:08 PM

State employees have not been able to use SFMC with UHC and they couldn't use their previous insurance there either. I don't know how many state employees there are, including their families, but I would think there are quite a few in this area. Thank you SFMC for not considering us now, or in the past.

They are saving their money to pay their million dollar ad campaigns.

-- Posted by trustme on Fri, Nov 12, 2010, at 3:42 PM

This is great what St. Francis is doing, but I have a daughter who may be starting school this Fall. I am on a UHC plan too, but I am not a SEMO employee. The problem is there are no trauma centers on the network near Cape Girardeau. If she were in a car accident she'd be taken to the trauma center and the expenses would be out of pocket. I would imagine students who live in Cape for 8 or 9 months out of the year are in this predicament if their parents' health network does not include St. Francis. I was just wondering what other parents of SEMO students do in circumstances like this when they are from out of town.

-- Posted by DDalton on Fri, Nov 12, 2010, at 4:14 PM

Like I said before, St Francis has not even received a contract from UHC so how can it be that the reimbursement is so much lower than Southeast? St Francis will not entertain a contract from UHC is my understanding from the brokers. I have been trying to get SFMC to work with UHC, too, since I work in the healthcare industry here. But SFMC won't even talk to UHC. If you are listening, SFMC - join the UHC network for the sake of our local students.

-- Posted by healthfirst on Fri, Nov 12, 2010, at 4:48 PM

Forget St. Francis and use Southeast. If they don't want to be a part of the UHC network, then don't appease them. People have had UHC for years and have been gouged by them, now they want to offer a special group discounts, I wouldn't fool with them, because they are not in network, it doesn't go toward deductible.

-- Posted by whitey11 on Fri, Nov 12, 2010, at 5:09 PM

Thank you for your support Healthfirst. In the St. Louis area, UHC covers both SSM and BJC network of hospitals so it mystifies me why the region's only trauma care center is not on the network. I don't care whether it's UHC or STF that won't rectify this. Whitey, my point is if there is an accident, the ambulance will probably take the injured to STF regardless of insurance, and if my child is bleeding, I'm not going to want to worry about having a conversation about insurance benefits. STF, if I understand what they are saying correctly in this article, agrees to cover UHC at in-network levels, but in-network and out of network benefits/deductibles/out of pocket expenses are tracked separately I believe. In a college town, with one level III trauma center, it would be nice to have this resolved before the moment of need comes.

-- Posted by DDalton on Fri, Nov 12, 2010, at 8:10 PM

Trustme, BCBS does include the St. Francis, so I'm surprised to hear that state employees couldn't use St. Francis either as in network hospital. In trying to unravel the issue here, I always find one party blames the other in circumstances like this - I don't think anybody is getting the straight story. Part of me even thinks it is irresponsible of a major employer in the same town as the town's only trauma center signs up with an insurance provider that doesn't consider St. Francis as in-network. These are tough times, with escalating medical costs - no doubt about that. But managed healthcare networks that do not cover both hospitals in a small town such as ours, where many services might be found only at one hospital, place the residents of out-state MO at a huge disadvantage here. Perhaps SE can provide the same services as St. Francis. I don't know, and if so, I apologize to SE if my comments appear to underestimate SE. My mother, as a nurse, worked at both hospitals.

-- Posted by DDalton on Fri, Nov 12, 2010, at 8:27 PM

Having workd in the healthcare field for over 20 years before retiring this year, I know St Francis was considered a Metro or Urban facility whereas SE Hospital or as it is now known as SEHealth was considered a rural hospital. Blue Cross paid St Francis the same as Barnes Jewish,etc. BCBS paid SE the same as Dexter, Sikeston and all the other smaller hopsitals. I know when I was in SE and St Francis I could tell by looking at my EOB who had a bigger discount on the reasonable and customary charges.

The sad part is when I retired from my job at a local hospital I went to work in another field to keep busy. I was offered health insurance there that had a LOWER deductible and it is half the price I was paying when I worked for a hospital.

Do I miss the healthcare field? Yes and No. I miss helping those in need but not the stress of someone who sits in a office breathing down my back all day. Politics is all healthcare is about anymore.

-- Posted by joekool on Sat, Nov 13, 2010, at 5:13 AM

So many comments by so many people who have no clue what they are talking about. "Working in the healthcare industry" gives one no knowledge of how insurance works, how contracts are negotiated and written, and why a provider is in-network or out-of-network. The reasons why or why not St Francis is not a network provider for United Health Care are unknown to anyone who has commented here, including me. They are known only to the highest level executives at both organizations. But, everyone thinks the reasons are so simple, not true. When a health care provider (like Southeast) agrees to become "in-network" they agree to accept a negotiated amount for their services. There are a lot of reasons why, but a primary one is volume. They can get more customers for their services, and those customers are "required" to go there. Both the insurance company and the hospital like this, and for it to work effectively you need to limit the in-network providers in an area as small as Cape Girardeau. If you don't, then the advantage no longer exists and you have to raise premiums. That is why Anthem's rates are so high and United can offer a better deal to SE MO State. Saint Francis's great offer, sounds great, but really is not for most people. For small medical bills (let's say $500) many people can pay within 45 days. For huge bills (have surgery and find out you owe $5,000) most people can't pay within 45 days. Especially since a medical problem like that may mean time out of work or other expenses. Most large medical bills are paid over months, if not years. Although the SFMC offer sounds great, it is not so great for the majority of consumers. Just to complicate this problem - even though SFMC may offer this new discount plan, users will find United Health Care doesn't cover the same physician providers as Anthem.

-- Posted by ParkerDaws on Sat, Nov 13, 2010, at 7:11 AM

Oh, forgot one more thought. It was Southeast MO State University that chose United Health. They did so knowing full well that St. Francis was not in-network. They did so knowing how many of their employees use St. Francis. They made the choice. They made the choice to save lots of money. A lot of that savings was passed to their employees in premium cost and better level of coverage. But, I guess that wasn't enough. We seeem to want everything. If you don't like the coverage, either lobby the university or get another job.

-- Posted by ParkerDaws on Sat, Nov 13, 2010, at 7:17 AM

ALL hospitals are a scam for money.It seems the only people in this ecomomy making money are the hospitals.Now they just are ready to let people know they can make a "deal" if you come to their hospital.

-- Posted by mohacker on Sat, Nov 13, 2010, at 10:11 AM

to DDalton: the federal healthcare law states that during an emergency, out of network facilities will be considered in network. I do believe it has to be a true emergency though. In the situation you mentioned, if your daughter was injured in a car accident and taken to SFMC because it was the area's trauma center, it would be considered in-network. Hope that helps.

-- Posted by mytwocentstoo on Sat, Nov 13, 2010, at 11:25 AM

Join the network, SFMC.

-- Posted by vietnamvet on Sat, Nov 13, 2010, at 4:59 PM

Thank you for the response my$.02. I have looked into this scenario with UHC and their reply was that the hospital would be considered out of network. I would probably need to research that federal healthcare law myself. I also understand what ParkerDaws is stating, but in Cape's situation, services provided often are available exclusively, so a network unduly burdens the rural residents of Cape as well as the families of students who require medical treatment. As I mentioned UHC covers both SSM and BJC networks in the St. Louis area. I am a former resident of Cape.

-- Posted by DDalton on Sat, Nov 13, 2010, at 6:51 PM

All this discussion is regarding how much it costs to have someone else pay your medical bill. The focus is in the wrong place. Why is your medical bill so much ?

Aren't we just as greedy as those evil employers who want the lowest premium possible, or those insurance companies that promise the moon at the cost of a steet light or is it those hospitals that want to provide the best care and enjoy the benefits of their sacrifice?

The fact is that the farther the consumer is from the provider the more room we have to point fingers. As much as we enjoy blaming others, we are also the problem. The "I want" people are in high supply and the "I have" people are in such demand that the two will balance out only in the market place. No regulation passed by any legislature will repeal the LAW of supply and demand.

-- Posted by yy4me on Sat, Nov 13, 2010, at 6:54 PM

This is the primary reason we do not use St Francis will cave in Francis and use SE hospital. St Francis will cave in if you threaten to go to Southeast then suddenly they will work with my UHC. If they caan do it for less then think of the overcharging they do to other patients.

-- Posted by semolover on Sun, Nov 14, 2010, at 4:05 PM


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