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MCO Provider Networks

January 28, 2021 3:15 PM | Anonymous member (Administrator)

Rumor control:

We got a question recently from an associate member asking about a rumor one of his newer customers related. This provider was convinced that United Healthcare was involved in negotiations with a couple of national providers with the intent of entering a sole-source, nationwide contract for home oxygen service. The customer was panicky about what would happen after the pandemic when the demand for oxygen returned to “normal” levels, leaving him or her stuck with zillions in excess concentrator inventory. It ain’t gonna happen…

Now, we can’t say there are no such negotiations going on, only that several states prohibit such practices and our national organizations are doing their best to keep it from happening, not to mention the complaints that would be generated in rural areas, especially, where service is hard to get under any circumstances, much less from a low-bidder with no presence anywhere near the market.

We suggested trying to introduce that provider to the serenity prayer popular with many twelve-step programs. You know the one—it usually goes something like this: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Many years ago, I had a good friend—Norman— who was an accountant, employed for may years by the Internal Revenue Service in collections. He had gone to work for this new-fangled sort of insurance company, formed as one of those organizations that were going to rescue the USA healthcare delivery system from bankruptcy or worse, called a health maintenance organization, an HMO. It was called United Healthcare, and Norma’s job was to visit hospitals in his territory and tell them how much United would pay them to care for their subscribers. He didn’t negotiate anything, he simply announced the number of covered lives in the hospital’s service area and tell the administration that they had two choices—take what United wanted to pay, or watch all those patients being admitted to some other hospital. He did the same thing with physicians and other providers, and the reason he got away with it was that United sold health “insurance” coverage to large groups at rates lower than any insurer licensed to do business in the state.

They captured all those insured lives by being the cheapest insurer of any kind in any market and stayed profitable by gouging all potential for profit out of the providers who cared for those patients. You can imagine the kind of care provided.

I don’t know about their other big profit contributor back then, as my friend didn’t have anything to do with claims processing, but in recent years, United management has admitted in all sorts of public forums that they also try very hard to avoid paying for anything at all, and if they have to pay, to delay it as long as possible. That may be good for management and investors, but it certainly isn’t good for healthcare providers and patients.

It was a long time ago that I first heard the expression “you get what you pay for,” and that is definitely true when buying insurance from United, more than any MCO.

Back in the eighties, I first met industry pioneer Shelly Prial when he and I attended a program where we were the only two people in a large crowd who disagree with a panel of speakers who insisted that in ten years or less, the only survivors in HME would be full-line national or very large regional companies. It wasn’t true then, it isn’t true now, and I am convinced that it never will be.


  • January 29, 2021 9:23 AM | Anonymous member
    Since there's no "LIKE" button, I'll just say
    ::thumbs up::
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