Disney HMO plans draw ire of some
Walt Disney Co. has rolled out an insurance plan for its Central Florida employees, which involves two major local health systems and bypasses insurance companies — likely the first of its kind here, Orlando doctors say.
The company says it wants to lower costs while maintaining the quality of care, but the arrangement has upset some patients and independent doctors.
Here’s how it works: Disney has directly contracted with the area’s two main health systems, Orlando Health and Florida Hospital, to create two plans. One plan is restricted to Orlando Health’s network of doctors, hospitals and facilities, and the other is limited to Florida Hospital’s network. Patients who go outside of either network won’t have coverage, except for special circumstances.
“So what has happened is that the two hospitals have agreed at some level to be a partner [with Disney] and take
the risk, charge less and provide the services,” said Brian Klepper, an independent health benefits workplace consultant.
Disney also offers a Cigna HMO plan, but only to employees who don’t have access to Florida Hospital and Orlando Health networks where they live. The company continues to offer two other Cigna plans with larger networks, with deductibles that are three to five times higher.
Disney did not agree to be interviewed for this article. It said in a short statement that it’s committed to providing its employees “with high-quality healthcare options at an affordable price.”
Orlando Health and Florida Hospital didn’t comment and referred the Orlando Sentinel’s questions to Disney.
Experts say the arrangement is probably how Disney has managed to keep employees’ health insurance costs similar to last year as many other employee plans are going up.
But some Disney employees are upset because they didn’t realize that their doctors were not included in the health system plan they chose. Similarly, independent physicians who are not in either hospital’s network are concerned not only because they’ve lost patients, but also because they worry that other large local employers may follow suit and further marginalize their practices.
“We’ve had so many patients who have expressed frustration that they didn’t understand what they signed up for,” said Dr. Edwin DeJesus, an infectious disease physician in Orlando. “It wasn’t very wellexplained. … It’s not until they come to the office and we can’t take their insurance.”
His practice, Orlando Immunity Center, which cares for Central Floridians with HIV, hepatitis and other infectious and sexually transmitted diseases, has lost nearly 200 patients since the new Disney plans went into effect at the beginning of the year.
“I have had to say goodbye to some of my patients after caring for them for 10, 15 years,” DeJesus said.
With more than 70,000 employees, Walt Disney World is the largest employer in Central Florida. Florida Hospital and Orlando Health have the largest market shares.
“[Disney] probably said, ‘We can negotiate a good deal if we have enough market power. We don’t need an insurance company in order to contract with [the health systems].’ And they hire somebody to administer the plans,” said Katherine Hempstead, a senior adviser with the Robert Wood Johnson Foundation.
A national survey of 1,300 employers in 2012 showed that nearly 40 percent were interested in directly contracting with a provider network, because they could eliminate the cost of contracting with an insurance company. The employers usually hire a third-party company to manage the claims, since the plans have the typical elements of health insurance, including premiums and deductibles. In this case, Disney has hired Allegiance, which is a Cigna company.
“This is another consolidation that’s pulling patients away from independent doctors,” said Marni Jameson Carey, executive director of Winter-Parkbased Association of Independent Doctors, who said she’s been in talks with Disney to advocate for doctor members of her organization who have been affected by the arrangement.
Orlando Health and Florida Hospital each have their own network, which includes employed and independent doctors. But not all independent doctors want to join these networks because they have to give up their patient data and it undermines their autonomy, Carey said.
Disney started pushing out information about the new insurance plans some time last year and gave the employees time to learn more about the plans during a three-day event at the end of October called Disney Benefits Showcase. Florida Hospital and Orlando Health have also set up special websites for Disney employees with access to a list of providers.
But the language still wasn’t clear to some.
“They said we had a choice between Orlando Health and Florida Hospital, and since it looked like all of our doctors were at Florida Hospital, we figured we keep Florida Hospital,” said Pearl Hansen, whose husband works for Disney. The couple is in their early 60s.
But she found out in January that she could no longer go to her primary care provider, and she isn’t happy with the new one she’s had to choose within the health system’s network. “And if we had referrals for specialists, we have to go back to the new doctor to get new referrals... There’s an old military term to describe this: FUBAR,” she said with a laugh.
Whether this arrangement will lead to better care at lower cost is yet to be seen.
“I think the decision that Disney has made will be an interesting opportunity to view outcomes and see if it’ll reduce health-care costs,” Jones. “I think the jury is out.”