A dispute over the rates paid by insurance carrier Oxford Health Plans to Jamaica Hospital Medical Center threatens to disrupt patients and damage the financial stability of the hospital.

Oxford informed doctors and patients earlier this year that it would stop making payments for care at Jamaica Hospital. The medical center then sued the insurance carrier in state court to force the company to honor a contract signed in 2004, according to hospital officials. The ongoing court proceeding has allowed Oxford patients to continue receiving care at Jamaica.

At the center of the dispute is the rate Oxford pays for care. Jamaica Hospital officials said the 2004 contract requires Oxford to pay at a higher rate, while the insurance company has continued to pay rates equivalent to those paid before the contract went in to effect. Without going into detail, Oxford officials contend that the 2004 contract was terminated��"something Jamaica Hospital disputes.

Over the past year, the difference between the bills Jamaica Hospital has submitted to Oxford and the amount of money the hospital received totaled tens of millions of dollars.
 
About 500 doctors in the Oxford network have admitting privileges to Jamaica Hospital, according to Maria Shydlo, a spokeswoman for United Health Care. If Oxford were to stop accepting payments for care at the hospital, the consequences would be devastating for the institution’s finances.
 
“If they leave, it’s not going to put us into bankruptcy, but as with all hospitals if you cut out any portion of our revenue it’s damaging,” said Michael Hinck, Jamaica Hospital’s director of public affairs.
 
Hinck said the hospital is already struggling to keep afloat. Much of its patient population draws from Jamaica, Howard Beach and several working class neighborhoods, where many residents have no health insurance.

Despite her company’s moves, Shydlo said that Oxford wants to continue providing service at the hospital once the dispute is worked out. “We hate to see a hospital leave the network. We want to provide members with broad access to care and we like to have as many physicians as possible in the network,” she added.

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by Christopher Henderson, ChrisH@qchron.com

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