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What you need to know if you have a UnitedHealthcare plan

Premier Health and UnitedHealthcare have not reached a contract agreement, meaning close to 70,000 with UHC plans can’t use their insurance at Premier hospitals or doctor offices.

Many UHC policyholders will now have to find new in-network providers in the Dayton area.

RELATED: Contract talks threaten 70K UnitedHealthcare members in Dayton area

Final deadline looms for UHC and Premier Health negotiations

“Despite repeated efforts to reach a compromise, all of Premier Health Network’s proposals maintained their position as one of the most expensive health systems in Southwest Ohio and demanded local businesses be restricted from offering competitive benefits that put consumer choice first and allow workers to be rewarded for choosing quality, cost efficient care providers,” UnitedHealthcare said in a statement Saturday evening.

RELATED: 5 things to know if you have UnitedHealthcare insurance

Dayton-based Premier, the largest health system in Southwest Ohio, has taken issue with UHC’s health plan design, which ranks hospitals and providers in tiers based on cost and quality.

UHC, the nation’s largest health insurer, argues its plan design encourages consumers to choose the most cost-efficient care providers, helping to drive down health costs for consumers in the long run.

But Premier argues it would be inherently disadvantaged by the tiered system, which, officials said, would also limit consumer choice.

“Premier Health remains committed to resolving our differences with UnitedHealthcare as soon as possible while protecting patient choice,” the company said in a statement Friday. “We continue to keep the lines of communication open out of great concern for our patients.”

RELATED: Premier, UnitedHealthcare still open to negotiations

Seniors with UHC Medicare Advantage plans have been shielded from the current contract talks. The two sides agreed late last month to extend their network relationship for UHC Medicare Advantage plans through the end of the year, providing policyholders with uninterrupted access to Premier hospitals and physicians.

Here’s a look at what is happening:

» Physicians employed by Premier are out of network for UHC members with employer-sponsored and individual health plans, as well as those with UHC-managed Medicaid plans. We are asking both sides about what patients need to do to transfer their medical records to other health systems.

» Seniors with UHC Medicare Advantage plans are OK. The two sides agreed late last month to extend their network relationship for UHC Medicare Advantage plans through the end of the year, providing policyholders with uninterrupted access to Premier hospitals and physicians.

WHAT ARE THE CHANGES?

» Premier hospitals are already out of network for UHC members with employer-sponsored and individual plans because the two sides couldn’t reach agreement on their hospital contract by April 29.

HOW MANY PEOPLE ARE AFFECTED?

» About 70,000 Dayton area residents are enrolled in UHC health plans.

WHY IS THIS HAPPENING?

» The main issue in the contract dispute was UHC’s new health plan design, which ranks hospitals and providers in tiers based on cost and quality. Premier argues it would be inherently disadvantaged by the tiered system, which, Premier says, would also limit consumer choice. UHC argues the plan design encourages consumers to choose the most cost-efficient care providers, helping to drive down health costs for consumers in the long run.

RELATED: 5 things to know if you’re UnitedHealthcare member

WHAT’S NEXT?

Failed contract negotiations have left thousands of UHC policyholders scrambling to find new in-network providers in the Dayton area, although UHC was quick to point out that it will continue to offer a broad network of participating hospitals in southwest Ohio, including:

•Dayton Children’s Hospital

•Grandview Hospital

•Greene Memorial Hospital

•Kettering Medical Center

•Medical Center at Elizabeth Place

•Soin Medical Center

•Southview Hospital

•Springfield Regional Medical Center

•Sycamore Medical Center

RELATED: Premier Health, UnitedHealthcare at odds over health plans

REACTIONS FROM BOTH SIDES:

“At Premier Health, we want to reach a reasonable contract with UnitedHealthcare as soon as possible to minimize disruptions for our patients. However, we don’t want that resolution to come at the expense of patient choice,” Premier said in a statement.

“As one of the most expensive health systems in Southwestern Ohio, Premier continues to make demands that would prevent employers from giving their workers incentives for choosing quality, cost efficient care providers and instead, insists on continuing to drive up costs for the community,” UHC stated.

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