AHCA: Universal Health Care HMO Termination

Effective March 21, 2013, Universal Health Care, Inc. was ordered into receivership for purposes of rehabilitation by the Second Judicial Circuit Court in Leon County, Florida. The Florida Department of Financial Services, Division of Rehabilitation and Liquidation, is the court appointed Receiver of Universal. Effective April 1, 2013, pursuant to the Court Order, Universal will automatically move into receivership for purposes of liquidation.

Universal is licensed as a health maintenance organization in Florida. The company had approximately 40,000 Medicare members, approximately 60,000 Medicaid members and approximately 1,400 Nursing Home Diversion Program members as of February 2013. It is a Florida corporation which was licensed in February 2003 and is headquartered in St. Petersburg.

Policy cancellation effective 12:01am on April 1, 2013: By Court Order, effective at 12:01am on April 1, 2013, all contracts for health care coverage provided by Universal that have not already expired are automatically canceled. Policies or contracts of coverage with normal expiration dates prior to April 1, 2013, or which are terminated by insureds or lawfully canceled by the Receiver or insured before April 1, 2013, are considered canceled as of the earlier date.

Who will pay claims for services rendered prior to the effective liquidation at 12:01am on April 1, 2013? Universal will continue its normal day-to-day activities while it is in rehabilitation and will pay claims during this period in accordance with its normal business practices. Claims which were not paid as of the liquidation, which is effective at 12:01am on April 1, 2013, will be considered as claims against the Universal estate and subsequently processed by the Receiver during the liquidation process. Detailed information regarding the filing of claims in a liquidation proceeding will be available on the Receiver’s website in the near future.

Claims for services or goods provided to or on behalf of the Universal members must be filed with the Receiver on the Receiver’s Proof of Claim Form in order to be considered for payment. The procedure for the filing and evaluation of claims in a liquidation proceeding is set out in Part I, Chapter 631, Florida Statutes. Assuming there are sufficient assets in the receivership, the Receiver will evaluate claims in order of their priority as set out in Section 631.271, Florida Statutes. This statute establishes a system of priorities in paying claims. When the evaluation process has been completed, the Receiver will file a report with the Court setting out our recommendations as to the amounts, if any, which should be allowed on each of the claims evaluated. Notice of the Receiver’s recommendations and the deadline for filing any objections to the recommendations will then be provided to the claimants. It is unlikely that claimants will receive any correspondence or other communication from the Receiver until that time unless the Receiver has questions regarding the claim which has been filed. This is because the Receiver is trying to minimize the claims’ processing costs in order to maximize potential distribution to the claimants.

During the claims evaluation period, the Receiver also commences litigation and/or takes whatever other action is necessary to collect and maximize the assets of the receivership estate. Please note: after the liquidation date of April 1, 2013, it may be several years before distributions, if any, are made in this receivership. Distributions of assets are made on a pro rata basis in accordance with the priority of claims which is set out in Section 631.271, Florida Statutes. Those whose claims fall into lower priorities are paid only if there is money left after paying the higher priority claims. It is too early in the receivership process for the Receiver to provide any estimate as to the timing and/or the pro rata percentage of the distributions, if any, which may be made in this receivership.

Additional general information concerning the receivership process is available here.

Can providers seek payment from Universal members for debt owed by Universal for medical services? No. Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services.

Coverage information – Medicaid members: Enrolled Medicaid members have continued health care coverage with Universal until 12:01am on April 1, 2013. Such recipients will receive a letter from the Agency with details regarding their continued health care coverage after April 1, 2013, and new Medicaid health plan assignment, if applicable. MediKids will be enrolled in a new Medicaid health plan effective April 1, 2013, and will continue to receive covered medical services from their new health plan. All other Medicaid recipients will receive covered services through fee-for-service Medicaid effective April 1, 2013. Recipients required to be in a managed care plan will receive information regarding their new Medicaid health plan which will become effective May 1, 2013.

Contact information: Prior to April 1, 2013: Providers and members may visit the company’s website at www.univhc.com, e-mail the company at CustomerService@univhc.com or contact the company directly as follows:

Universal – Direct Contact Information:

Customer services: 1-866-690-4842

Pre-Certification:
Physician Authorization Request:
Telephone: 1-866-690-4842 ext. 2989
Fax: 1-866-420-4842

Concurrent Review:
Hospital Authorization Request, Notification, and Clinicals
Skilled Nursing Facility Authorization Request, Notification and Clinicals
Telephone: 1-877-386-6670
Fax: Hospitals: 1-800-889-6745
Fax: Skilled Nursing: 1-877-261-2148

Case/Disease Management:
Telephone: 1-866-616-6398

Provider Relations & Network Services:  1-877-661-3920
Email:  Providers@univhc.com
Main office number: 1-866-690-4842
Mailing Address: 100 Central Ave., Suite 200, St. Petersburg, FL 33701
Website: www.univhc.com

Medicare information: Providers and members needing more information regarding Medicare, other Medicare Advantage plans, or coverage options from 12:01am on April 1, 2013, should visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Medicaid information: Recipients needing more information regarding other Medicaid health plans should visit www.ahca.myflorida.com or call 1-866-454-3959, TDD users 1-866-467-4970 if in Broward, Baker, Clay, Duval and Nassau Counties. Medicaid recipients in all other counties should call 1-888-367-6554, TDD users 1-800-653-9803.

If you have further questions, please contact your local Medicaid area office.

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