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.
People with certain medical conditions who are insured by UnitedHealthcare may still be able to go to a Premier Health hospital or doctor’s office.
Pregnant women or people who were recently diagnosed with cancer may still be able to go to Premier facilities if they are eligible for “Continuity of Care,” said Anthony Marusic, spokesman for UHC.
Both Marusic and Ben Sutherly, spokesman for Premier Health, answered questions for the Dayton Daily News about how the contract dispute could affect residents.
1. What should a person do if they have UnitedHealthcare and had a surgery scheduled at a Premier Health facility?
UHC: They may be eligible for Continuity of Care. UnitedHealthcare members should call the number on their health plan ID card with questions about Continuity of Care and to learn more about qualifying conditions.
Premier: Premier Health’s schedulers have reached out to patients to cancel surgeries unless an out-of-network authorization was received for those patients.
2. Are you doing anything to help patients who may need to go to another doctor until a deal is reached? What options are you recommending to patients who would normally see a doctor with Premier Health?
UHC: We are working directly with our members who may have ongoing health concerns or may be in the middle of a treatment at a Premier Health facility or with a Premier physician to ensure appropriate accommodations are made to avoid disruption in their care.
Members who are pregnant or undergoing treatment may qualify for Continuity of Care, which provides continued in-network benefits for a period of time. These benefits are subject to the hospital’s contract, the member’s benefit plan, applicable law, and will be limited to a specified period of time.
Premier: Premier Health has notified UnitedHealthcare members who have received care at Premier Health in the past about the situation. In addition, employed primary care physicians with Premier Physician Network (family practice, internal medicine, pediatrics) will continue to provide services to UnitedHealthcare commercial members for a co-pay of $25 through Dec. 31, 2017. (Patients will have no out-of-pocket expense beyond the $25 copay.) Patients were informed of this option through a letter sent in early May.
3. What does someone need to do to transfer medical records to see a new or temporary doctor?
UHC: We are fortunate to have relationships with several other hospitals and physicians in the area to ensure the families we serve have uninterrupted access to the care they need. For information regarding in-network providers, members can call the number on their Health Insurance card. Members can also find network hospitals and physicians online at: myuhc.com.
Premier: In many cases, UnitedHealthcare members might not need to switch doctors. Employed primary care physicians with Premier Physician Network (family practice, internal medicine, pediatrics) will continue to provide services to UnitedHealthcare commercial members for a co-pay of $25 through Dec. 31, 2017. Patients will have no out-of-pocket costs beyond the $25 copay. However, in cases in which a patient finds it necessary to switch providers, they should contact the appropriate provider’s office.
4. If someone with UnitedHealthcare was in a car accident and taken to a Premier Health hospital, what would that mean for that patient?
UHC: UnitedHealthcare members should always go to the nearest hospital in the event of an emergency and their services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.
Premier: A patient who receives emergency care is not responsible for the full bill. However, patients should be aware that they will be billed for any costs not paid by UnitedHealthcare.
5. Where do negotiations stand at this point? Do you expect a deal to be reached soon and have the two parties set another date to try to reach an agreement by?
UHC: UnitedHealthcare’s goal remains to find an acceptable solution that would renew in-network access to Premier’s hospitals and physicians with a contract focused on quality, affordable health care that preserves consumer choice. We’re hoping Premier will be open to continued discussions.
Premier: Premier Health remains committed to resolving our differences with UnitedHealthcare as soon as possible while protecting patient choice. We continue to keep the lines of communication open out of great concern for our patients. The upheaval that UnitedHealthcare is creating for its members in the middle of a benefit year is disappointing, especially in light of the fact that we have offered to forgo a nominal increase in rates throughout 2017 – an offer that UnitedHealthcare rejected. We greatly appreciate that local employers are taking steps to ensure that their employees continue to have a choice of providers for their health care needs.