Prisma no longer in network for UnitedHealthcare insurance plans

GREENVILLE, S.C. (FOX Carolina) – After they failed to reach an agreement by the end of the year, South Carolina’s largest healthcare system Prisma Health is out-of-network for patients with UnitedHealthcare as of Monday.

No deal was reached after months of heated negotiations.

Prisma Health accused UnitedHealthcare of failing to recognize the “extraordinary inflationary cost” the system is incurring. UnitedHealthcare argued a 24 percent price hike demanded by Prisma was “outlandish” and said the organization did not counter their last proposal.

Below is a statement from UnitedHealthcare:

“Prisma Health did not counter our Dec. 27 proposal and allowed our contract to expire. Throughout our negotiation, Prisma maintained its demands for outlandish price hikes that would have made its hospitals nearly 25% higher cost than the Columbia and Greenville market averages and its physicians nearly 50% higher cost in those markets. While we remain open to continued discussions should Prisma provide a proposal that’s affordable for consumers and employers, our focus now is on ensuring South Carolinians have access to the care they need through either continuity of care or a seamless transition to a new provider.”

Below is the statement Fox Carolina received from Prisma:

“As of Jan. 1, United Healthcare (UHC) has placed Prisma Health as out-of-network for its health plan members. We are in this situation because UHC refuses to enter a reasonable agreement that reimburses us for the cost increases we have and continue to absorb for their health plan members. Prisma Health has been able to come to agreements with all other major insurance companies we have negotiated with during the past year because they recognized the increased costs that Prisma Health has incurred – all except UHC. This is just more evidence that Prisma Health is being reasonable, but UHC is not.

UHC references a Dec. 27 proposal that was submitted in response to Prisma Health’s proposal dated Dec. 26. As with previous proposals submitted throughout our negotiation, UHC showed no good–faith movement in their last proposal and left the economics largely unchanged. In our last communication to UHC on Dec. 30, we reiterated our commitment to enter an agreement that would maintain Prisma Health in-network and asked them to submit a reasonable proposal. UHC refused to do so, which resulted in them placing Prisma Health as out-of-network.

UHC continues to use very misleading information about the sequence of events and the economics of the proposals that have been submitted. Specifically, UHC continues to reference “near 20%” requested increases over 12 months. This is simply not true. Although it is our policy not to disclose specific details about our negotiations, Prisma Health’s requests to UHC have been less than 10% a year over a two-year timeframe. In addition, we have proposed alternative reimbursement mechanisms that would lessen the rate impact on employers. UHC has ignored those proposals. In addition, Prisma Health has requested Medicare Advantage rates consistent with market-competitive reimbursement. UHC remains unwilling to sacrifice their own profit margin and provide appropriate payment rates for services we provide to patients covered by UHC Medicare Advantage plans.

Patients with a UHC Medicare Advantage insurance policy who want to continue to keep their relationships with the doctors they trust have options by switching to a plan that includes Prisma Health as in-network during the annual open enrollment period. The annual Medicare Open Enrollment period runs Jan. 1 through March 31, 2024.”

UnitedHealthcare said some customers in the middle of treatment with a Prisma Health provider, such as pregnant women or patients in active cancer treatment, may be eligible for continuity of care.

Copyright 2024 WHNS. All rights reserved.