Local UnitedHealthcare insurance members could have to pay more to see doctor

United Healthcare Center grand opening Wednesday, Sept. 14, 2011 on Fulton Street in Hempstead, N.Y. (Bill Kostroun/AP Images for UnitedHealthcare)

DAYTON, Ohio (WDTN) – Thousands of people in the Miami Valley could soon have to pay more to see their doctor at a Premier Health facility.

One of the largest group health insurance companies, UnitedHealthcare (UHC) and Premier Health network have weeks to reach an agreement before UnitedHealthcare insurance holders will have to pay out-of-network fees.

Their current contract is set to expire April 29th.

UHC has been notifying its members of what’s at stake while negotiations are in the works.

The problem between the two companies is transparency, according to UHC Executive Director Caitlin Clipp.

Clipp says UHC’s insurance plan design showcases price transparency by ranking area hospitals and comparing costs for services.

“Premier Health Network wants its hospitals to be considered Tier 1, but won’t commit to meeting the cost efficiency requirements to be Tier 1. Listing Premier Health facilities as Tier 1 when they do not meet the cost efficiency requirements would be inappropriate and unfair to our employers and members,” said Clipp.

2 NEWS reached out to Premier Health for comment and received the following statement via e-mail:

“Premier Health is reimbursed for approximately 500 kinds of diagnosis-related groups. For some kinds of procedures, we receive more reimbursement than other health systems and hospitals do; for other procedures, we are reimbursed considerably less. For UnitedHealthcare to call attention to any one particular example is a gross distortion of the facts.

In addition to distorting the pricing issue, UHC has also grossly distorted the issue of “tiering.” The issue is not about transparency.  Indeed, UHC has provided for transparency through their web site for many years and continues to do so. Premier does not object to such transparency tools.

The issue is about only one of UHC’s many products.  The product provides incentives for enrollees to utilize non-Premier facilities and providers.  Premier is not willing to offer UHC the significant discounts currently in place for a product which intentionally directs patient away from Premier facilities and providers.  UHC has indicated that the number of enrollees in this product are very few in the Dayton market. 

Premier’s position is that we do not wish to participate in such a product.  Premier is more than willing to continue to participate in other UHC products which constitute the vast majority of UHC’s 70,000 clients.

It is regrettable that UHC has taken the position to deprive access to Premier providers for the vast majority of their 70,000 enrollees to attempt to force our participation in this very small product.”

Dayton-area employers are also in jeopardy of seeing an increase in health insurance costs, according to Scott McGohan, CEO of McGohan Brabender, an insurance broker company.

“It’s really not Premier’s money to negotiate and it’s not UnitedHealthcare’s, it’s employers money. It’s the resources in our community, they are the ones paying the true cost of healthcare.and they care about it. Their employees are impacted by those costs, whether it be out of pocket cost, what they pay in contributions. The employers wants to mitigate costs and be concerned about the cost of healthcare then they want to know what healthcare costs. As we unpack that and look at one system to the next system, from one carrier to another carrier, they make really good decisions. When transparency is allowed to enter the market,” said McGohan.

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