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Hospital employees' health plan in limbo

Workers’ health plan is administered by insurer that dropped hospital from its network.

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By Ben Sutherly, Staff Writer 9:37 PM Wednesday, November 11, 2009

CONCORD TWP., Miami County — Medical Mutual of Ohio’s decision to drop Premier Health Partners from its network has left one Premier hospital, Upper Valley Medical Center, in limbo.

Medical Mutual is the sole third-party administrator of the Miami County health system’s self-insured health plan.

Mike Maiberger, UVMC’s president and CEO, said in a prepared statement Wednesday, Nov. 11, that UVMC is in the process of putting a plan in place “to ensure that UVMC employees will have the same, or a very similar, health insurance plan with another third-party administrator in the event that we are unable to reach an agreement with Medical Mutual.”

UVMC is Miami County’s largest employer. The decision affects 1,120 UVMC employees, plus 12 retirees who received health-care benefits as part of an early-retirement package in the 1990s. Employees were told of the decision Tuesday through a newsletter, hospital spokeswoman Gail Peterson said.

Medical Mutual confirmed Tuesday that it is terminating its agreement with Premier as of Jan. 1, 2010.

Ed Byers, Medical Mutual’s manager of media relations, said Wednesday that no plans to resume negotiations with Premier have been made. Medical Mutual received about 100 calls Wednesday from Dayton-area members seeking more information, he said. Medical Mutual members may call (877) 328-6664.

Premier spokeswoman Diane Ewing had said Tuesday that Premier’s proposed reimbursement rate for Upper Valley Medical Center was significantly less than those proposed for Premier’s other three hospitals: Miami Valley and Good Samaritan hospitals, and Atrium Medical Center. On Wednesday, Ewing said the lower proposed reimbursement rate for UVMC was not related to the fact that Medical Mutual is UVMC’s sole third-party administrator.

Medical Mutual is the third insurer to drop Premier Health Partners in the past five years. Humana Inc. dropped Premier a year ago, and Premier and Anthem were separated for one year after a contract showdown in late 2004. Premier rejoined the Anthem network in 2006.

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Are we missing something here? If Upper Valley is self-insured, that means they pay the bills themselves and they determine how much they pay on claims filed. Medical Mutual would only do the paperwork and get a fee for doing that.

K C
3:29 PM, 11/12/2009

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mlh-I want some of the drugs you're on.

HHhhhhmmmmmm
2:09 PM, 11/12/2009

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Don't you see that the unregulated free market system is the only salvation for the healthcare industry? It'll all work out, just like the financial industry, if we leave it alone. Trust in the humanity of the health care providers. Trust in the insurance providers. Trust in the medical brokers who match them up with consumers. They all only want what's best for you.

mlh
1:25 PM, 11/12/2009

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Well Duh...maybe your the moron that missed the part about UVMC being the lowest paid of the Premier Hospitals...kinda what the article was about. Now employees are left w/o coverage...Health care must be fixed and Private Insurance is THE major problem...when profits come before treatment....I really hope some of the major naysayers visit bankruptcy like I have over medical bills

Bill
12:25 PM, 11/12/2009

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Johio,
You give a perfect example of what's happening to people all over the country. We need health care reform is the worst possible way. Those that oppose reform are the ones who have no idea how our current system is bankrupting thousands of Americans.

Jim
12:13 PM, 11/12/2009

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