Tulsa-based insurer CommunityCare is severing its contract with Hillcrest HealthCare System over allegations that Hillcrest is billing members more than allowed, meaning 6,500 patients will have to find new primary-care physicians.
Thirty-four CommunityCare clients with HMO plans have called their insurer since late 2016 to complain that Hillcrest has over-billed them about $400,000 in total, according to CommunityCare.
CommunityCare has 140,000 members, of which only the 6,500 (about 5 percent) are affected by the move. The other 95 percent have physicians through St. John Health System or Saint Francis Health System.
Sharon Fletcher, president and CEO of CommunityCare, said the decision was difficult because health care is “personal” and “emotional,” but that the company’s first priority is to protect its members.
“We feel that the value system (we were founded on) has been damaged,” Fletcher said.
Hillcrest HealthCare System issued a statement Thursday that denied CommunityCare’s allegations, calling them “false and irresponsible.” Hillcrest defended its practices, “which are in adherence to all laws and regulations.”
Attorney Elise Dunitz Brennan, who is representing CommunityCare, said the insurer expects more client complaints of overbilling to surface now that the company has taken public action.
Brennan said Hillcrest is practicing “prohibited balance billing,” which is a violation of the contract between the two entities for charging patients more than their annual HMO rates for health services.
“The point of an HMO is to give some (financial) predictability to members,” Brennan said.
Hillcrest’s statement says the company will focus on providing its patients with “exceptional care.”
“CommunityCare’s public notice of termination is surprising and disappointing, given that we have been working together for months on re-negotiating our contract,” according to the statement. “We vehemently deny any allegations of wrongdoing; to claim that any of the billing practices in question violate state law is an egregious misstatement not based in fact.
“Hillcrest’s billing practices have been consistent with CommunityCare’s communication to the public through their website. CommunityCare has communicated for many years that some of their membership was covered by our contract and some were not; this information was clearly visible on their public website through their provider finder application. Our billing has been consistent with their communication of network alignment.”
Fletcher said the 34 complaints remain unresolved, with some clients suffering negative affects to their credit scores because bills were sent to collection agencies.
The contract between CommunityCare and Hillcrest was established in 2010, Brennan said, noting the complaints didn’t begin surfacing until late 2016.
She said CommunityCare has sent Hillcrest several notices to end the practice but hasn’t succeeded in halting it. She said “they think the contract language was different,” leading CommunityCare to wonder if perhaps new employees came to Hillcrest and re-interpreted the agreement.
“We have not filed a lawsuit and are choosing to deal with this situation through the termination of our contracts with Hillcrest,” Brennan said.
The change doesn’t affect Senior Health Plan or Advantage Medicare Plan members. CommunityCare is notifying members who will need to switch primary-care physicians and will help them with the process.
Fletcher said staff also will work with members who believe they might have been overbilled.
“We will pull up their claim history and walk them through it,” she said.
Fletcher said she isn’t anticipating any layoffs at this time related to cancelation of the Hillcrest contract.
The termination date for the majority of the contracts with Hillcrest facilities is June 30. Others are Sept. 1, 2018, or May 1, 2019. Medical appointments prior to the cancellation dates are still OK.