Providers left holding the bag in Florida

‘They’re saying it’s between us and Univita’
Friday, August 21, 2015

MIRAMAR, Fla. – HME providers are scrambling to get paid and to get in-network with health plans three weeks after the collapse of Univita Health.

Provider Ken Steber, who Univita contracted with to provide products and services to recipients in northern Florida, says he's owed nearly $500,000. 

“We’re fighting with the insurance companies to get some sort of resolution, but it’s not going too well,” said Steber, president of Pensacola-based Gulf Medical Services. “They are saying that’s between us and Univita, but they are ultimately responsible for these patients.”

Univita gained control of much of the Florida Medicaid market in 2014, when the Agency for Health Care Administration transitioned beneficiaries into managed care. Of the 14 managed care organizations running the program, 10 contracted with Univita to administer DME. Less than a year later, however, AHCA announced Univita was no longer processing prior authorizations and told providers to contact MCOs directly.

Provider Ivonne Gonzalez, who assumes she won’t be able to collect on her outstanding claims with Univita, has been working with several health plans. She’d like to get in-network, but she’s heard they’re only offering short-term arrangements—about 60 days, in most cases.

“So far, they aren’t proposing to let us into their networks after the transition,” said Gonzalez, president and CEO of Health Medical Equipment in Miami. “What are we supposed to do? Pick up our equipment?”

Providers hope the state will intervene, but AHCA has traditionally been hands off with how health plans handle their business, says attorney Dan Leyton.

“You can see where the MCOs might resist the idea of making good on Univita’s obligations,” said Leyton, a partner with Kravitz, Talamo & Leyton in Hialeah.

However things shake out, AHCA needs to think long and hard about how it wants to move forward, Leyton says.

“You have to wonder whether providers are going to want to continue to participate if they know that someday, a situation like this is going to happen again,” he said.



Providers who accepted bad contracts from Univita or others like them have no one but them selves to blame.
Payors do not provide services, only Provides do and we should if we are not treated Professionaly and Fairly. If all Providers walked away from these bad deals, Payors would have to come back and deal with Us on our terms.
AHCA and Plans will not pay Provides monies owed by Univita, why should they?

You must ask that at the State level who vets the MCOs and their extensions, like Univita.  Does an independent actuary run some numbers to see if the implementation plan and dollars will actually work?  The Florida model proved you can't throw and catch it too.   You can't administer and be a competing provider simultaneousy...particularly at rates below sustainability.   Speculating by not being in FL but I am guessing claim payments, denials etc were outrageously slow and numerous and that poviders were getting no relief from the healthplans.  What a model and that model is eveywhere.   AHCA has some explaining to do and should take a large part of the fault.   If it were me, there would be a job vacancy or two.  Total empathy for the Univita employees.