WILMNGTON – If you are the parent of a child in Delaware who receives health coverage through UnitedHealthcare, you recently received a letter stating that the current contract relationship between UnitedHealthcare and the Nemours Foundation (including A.I. duPont Children’s Hospital) is scheduled to expire on April 1, 2014.

I remain hopeful that UnitedHealthcare and Nemours will resolve their business differences so that UnitedHealthcare policyholders can continue to have A.I. duPont Children’s Hospital and Nemours pediatricians as in-network providers.  It is in the best interests of both parties and of the children they serve to resolve this issue quickly so that the care for these children is not interrupted or terminated.    Along with the Delaware Department of Health and Social Services, I stand ready to work with both parties on resolving this in the next few weeks.

However, because neither UnitedHealthcare nor Nemours appears to be making serious efforts to resolve their differences – despite the best efforts of the state – it is also important that parents make plans to ensure that their children receive appropriate medical care after April 1, 2014.  There is no “grace” period. Unless you take active steps in advance, services provided by Nemours will not be covered.  We suggest the following to make sure you are prepared:

• Children receiving Medicaid or CHIP benefits administered by United Healthcare.  Parents of children receiving Medicaid or CHIP benefits administered by UnitedHealthcare can ensure that their children continue to have access to Nemours pediatricians and A.I. duPont Hospital by calling the Delaware Medicaid Health Benefit Manager at 1-800-996-9969 and asking to switch their Managed Care Organization to DPCI.  The deadline for transfers is March 15, 2014. Parents who wish to remain with United Healthcare will need to select a new pediatric provider if they currently receive services from Nemours.

• Children whose parents receive self-insured health insurance benefits administered by UnitedHealthcare through a private employer.  There are two different ways that Delawareans receive health benefits overseen by UnitedHealthcare through their jobs.  Some Delawareans work for companies that are self-insured and hire UnitedHealthcare to administer their self-funded health benefit plans.  You can find out if your company is self-insured by asking your HR or personnel department.  Some of these self-insured companies use more than one insurance carrier to administer their benefits.  If your company uses more than one carrier, you should ask your HR department if the company is willing to allow you to switch to another carrier that has Nemours in-network outside the normal open enrollment period.  If your company does not use more than one carrier, you should talk to your HR department about any medical conditions your child has that make it important that s/he be seen at A.I. duPont Children’s Hospital, so your employer can make an informed decision about how to address the situation with UnitedHealthcare.

• Children whose parents receive health insurance from UnitedHealthcare through employer group health insurance or individually purchased health insurance.  If you are a UnitedHealthcare policyholder, through your employer or through a policy that you purchased directly from UnitedHealthcare, you have legal rights that are part of the insurance contract.  These rights include a minimal level of medical care that your child is entitled to receive.  If you have a child who is seen at A.I. duPont Children’s Hospital, you should immediately find out what UnitedHealthcare’s plan is for your child’s future medical care.  If you do not receive a prompt response or are unsatisfied with the response, you should contact the Delaware Insurance Department at 1-800-282-8611 or 302-674-7310 to receive help in enforcing your legal rights.

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