Mom of cancer survivor, 9, upset about hospital insurance contract battle in St. Pete

ST. PETERSBURG, Fla. (WFLA) – At just six weeks of age, doctors found a tumor on little Caleb Krzywkowski’s brain. 

“They found it and told us he had a tumor the size of a tennis ball and also cells down his spine,” said his mother Lisa Krzywkowski.

Their family pediatrician suggested they take Caleb to Johns Hopkins All Children’s Hospital in St. Petersburg.

“And they just love our son and every time he’s up there he’s made to feel like a little rock star. They know him and they love on him,” said Krzywkowski.

Her son endured 73 weeks of chemotherapy.

Now at the age of nine, Caleb appears to be cancer free, but he still has health issues related to his treatment and has to go in for annual cancer screenings.

On May 17, Krzywkowski was notified by her insurance provider, UnitedHealthcare, that they would no longer cover services at Johns Hopkins All Children’s Hospital and that any services there at the hospital, or from the doctors, would be considered “out of network.”

“The fact that they could just do that without any heart and that’s what I told them on the phone yesterday,” said Krzywkowski.

The hospital and insurance company are negotiating over payment for services.

UnitedHealthcare released a statement on Wednesday:

“All Children’s is paid competitive rates that are in line with other specialty hospitals in the St. Petersburg area. Despite UnitedHealthcare offering to increase their reimbursement rates by 20 percent, they continue to turn down our offers, insist on a 35 percent raise, and are deferring to an out-of-state consultant to manage the negotiation rather than working directly with our local team to reach a quick resolution.”

The president of the hospital blames the insurance provider.

“Right now, they are the lowest payer we have. They are actually known around the country as some of the worst payers to hospitals in the country. That’s how they make their money,” said Dr. Jonathan Ellen.

Dr. Ellen says right now the talks on the issue have reached a stalemate and no negotiations are currently taking place.

“Their 20 percent was what they opened with and they’ve not changed. They’ve not been willing to sit at the table and talk earnestly about what it takes to provide high quality health care for children,” said Dr. Ellen.

Lisa Krzywkowski just wants care for Caleb and right now, she doesn’t know where to turn.

“I just want him to receive the level of care that he deserves,” said Krzywkowski.

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