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The Real Deal: United Healthcare Medicare Patients, Out-of-Network at Albany Med
COLONIE – If you have UnitedHealthcare insurance through a Medicare or Medicaid program it may come as a surprise to learn that Albany Medical Center is out of the insurer’s network.
Gail Hoffman is a cancer patient, so when it comes to insurance, she has to do her homework, “I researched everything, made sure all my providers, the physicians were all in network, I checked my drugs to make sure they weren't going to cost me more,” she tells CBS6. She chose a new Medicare Advantage program this year through UnitedHealthcare that she thought would give her the best coverage for her care.
“You're not only dealing with just cancer and what means and what it's going to be like the next day when you wake up but you're also dealing with the medical costs and all the stress from that,” Hoffman told CBS6 Investigative Reporter, Jennifer Lewke. That stress got a whole lot worse when just one-week before a surgery at Albany Medical Center she found out the hospital is out of United’s network. “The woman at the desk where you sign in and register said to me, you know that you're responsible for 30 percent of the bill…your insurance is only going to pay 70% and I was just dumbfounded,” Hoffman says.
“Albany Medical Center is one of the top facilities in the area so why are they not participating?” she wonders. Especially since one of the two doctors who will perform one of her surgeries is considered in-network yet the hospital where it will be performed is not. A United Healthcare Spokeswoman says, Hoffman’s Ear Nose and Throat doctor practices in-network with University ENT and out-of-network as part of Albany Medical Center Otolaryngology.
UnitedHealthcare gave Hoffman two other local in-network hospital options but neither her ENT doctor or her Neurologist have privileges to preform surgeries at those locations. “It's work on my spine so I don't want to go someplace where I don't trust or even know the provider,” she says at the thought of a last minute switch.
A spokesman for Albany Medical Center tells CBS6 that the Hospital is an in-network provider with United for commercially covered patients with private insurance or through an employer but not with government sponsored patients. Albany Med, he says, has never been in United’s Medicare network. When asked whether the Hospital and Insurance company were in talks to bring the Medical Center into the network, he would not comment.
United says in a statement to CBS6, “Ms. Hoffman selected a Medicare Advantage PPO product with a $0 monthly premium and different co-pays and co-insurance for in- and out-of-network care for physicians and separately for hospitals. As we explained to her, since Albany Medical Center has not been part of UnitedHealthcare’s Medicare network and her physician will treat her there, she is responsible for 30 percent of the accepted Medicare rate, rather than 20 percent if she received care at an in-network hospital.”
Albany Medical Center is the only level-one trauma center in the Capital Region, so many wonder what would happen in an emergency situation. According to both AMC and United, a patient would pay the out-of-network price until he or she is medically stable at which time they could decide whether to be transferred to an in-network hospital.
After calls from CBS6 both the insurer and the hospital have offered to reach out to Hoffman and see whether she qualifies for any programs that would help off-set the increased price for the out-of-network coverage but she’s hoping her story at least serves as an alert to other seniors.