No deal between UnitedHealthcare and Premier Health

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) – Premier Health hospitals and other sites of service will be out-of-network with UnitedHealthcare as of midnight Saturday.

Premier Health’s 400 employed physicians will remain in-network until May 14.

However, the companies have extended their network relationship for Medicare patients through Dec. 31, 2017.

According to a press release, that means that beneficiaries will still have access to Premier hospitals and physicians.

However, Premier Health Network has not committed to renewing its contract for employer-sponsored and individual plans meaning likely its hospitals will no longer be in-network for commercial health plans as of April 30, 2017.

If a new agreement is not reached in the coming weeks, Premier physicians will also be out of network for employer-sponsored, individual plans, starting May 14, 2017. Both Premier hospitals and physicians would also be out of network for Medicaid plans on May 14.

Members should call the number on their insurance ID card with any questions.

UHC released the following statement Saturday:

Premier Health Network and UnitedHealthcare have extended their network relationship for UnitedHealthcare Medicare Advantage plans, providing beneficiaries uninterrupted access to Premier hospitals and physicians through Dec. 31, 2017.

However, Premier Health Network has decided to not renew its participation for employer-sponsored and individual plans, which means its hospitals are no longer in-network for commercial health plans as of April 30, 2017. We are committed to continuing discussions with Premier and working on an acceptable solution that ensures local employers can design competitive benefits that reward their workers for choosing quality, cost efficient care providers and restores network access to its hospitals.

Premier Health Network has not shown a willingness to compromise and meet in the middle on commercial health plans. Extending the current agreement means the health system will likely only repeat its same restrictive demands of employers eight months from now and put members in the middle of a negotiation once again. We are committed to reaching a long-term resolution with Premier that ensures stability and helps local employers design competitive benefits that reward their workers for choosing quality, cost efficient care providers.

If a new agreement is not reached in the coming weeks, Premier physicians will also be out of network for employer-sponsored and individual plans, starting May 14, 2017. Both Premier hospitals and physicians would also be out of network for Medicaid plans on May 14.

We appreciate the role Premier Health plays in Southwestern Ohio as a provider of quality care. UnitedHealthcare’s number one priority is supporting its members’ continued access to the care they need. Members should call the number on their insurance ID card with any questions, including assistance finding alternate providers and hospitals and discussing whether they may be qualified for Continuity of Care at a Premier facility.

Premier Health statement:

We are deeply disappointed that UnitedHealthcare has rejected our proposal to extend our contract until the end of the year. Our offer was put forth in good faith, and an agreement would have provided patients and area employers the opportunity to make choices about where and from whom to access care, during the normal open enrollment period for 2018.  By rejecting our offer, UnitedHealthcare has put thousands of their enrollees and area employers in the difficult position of possibly needing to find alternative providers of health care services mid-year.

While we generally don’t favor discussing negotiations publicly, we believe that this situation requires that we do so. Our offer was to extend the current contract until December 31, 2017, and in it we agreed to forgo any increase in rates. With a challenging health care environment in our region, this concession was significant and was done to eliminate disruption of services for our patients mid-year.

“We have been focused on how to best serve our patients and area employers during these negotiations with UnitedHealthcare,” said Mary Boosalis, president and CEO of Premier Health. “We put forth a proposal that included Premier Health forgoing a nominal rate increase.  An agreement would have provided choice for our patients and area employers that we believe they deserve.  We are extremely disappointed with the response from UnitedHealthcare, which disadvantages their enrollees.”

We continue to have a differing opinion on the issue of the tiered approach that UnitedHealthcare has demanded. However, a contract extension through the end of the year would have given patients and area employers a more convenient and timely opportunity to make decisions about the provider network they wished to select for 2018 during the normal open enrollment period, and would have avoided unwanted and unnecessary disruption.

 

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