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Medical Mutual to drop Premier from network

Third time in five years an insurer has dropped from Premier.

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By Ben Sutherly, Staff Writer 11:11 PM Tuesday, November 10, 2009

DAYTON — For the third time in five years, a private health-care insurer is dropping Premier Health Partners from its network.

The hospital network and Medical Mutual of Ohio confirmed on Tuesday, Nov. 10, that their agreement would be terminated Jan. 1, 2010.

About 1,000 Medical Mutual members in the past year have used services at Premier hospitals, including Miami Valley and Good Samaritan hospitals and Atrium and Upper Valley medical centers.

In July, Medical Mutual had about 4 percent of the Dayton area’s market share, according to Health Leaders Interstudy.

“We could not accept (Premier’s) rates, which would have made them the highest-cost health system in the state for us,” said Ed Byers, Medical Mutual’s manager of media relations.

Premier and Medical Mutual declined to name local employers who offer workers insurance through Medical Mutual. One is the city of Springboro.

“If in fact Premier is dropped, it’s obviously going to affect some of our staff,” said Chris Thompson, city manager.

Premier’s proposed rate hike for Miami Valley, Good Samaritan and Atrium was “reasonable” and less than the current rate of medical inflation (6.5 percent), Premier spokeswoman Diane Ewing said. In Upper Valley’s case, Premier was willing to accept a reimbursement rate significantly less than those proposed for Premier’s other three hospitals, she said.

Medical Mutual’s decision comes one year after Humana Inc. dropped Premier from its network.

Premier and Anthem were separated for a year after a contract showdown in late 2004, but Premier rejoined the Anthem network in 2006. Premier and Anthem’s current contract runs through 2010.

When asked about Premier being dropped three times by health insurance companies, Ewing said Premier has 55 percent of the share of the local adult market, but provides a disproportionate amount — 80 percent — of uncompensated care to adults.

“We have provided a high level of uncompensated care historically and felt it necessary to reflect this in our rates with third-party payers,” Ewing said.

Ewing said Premier is receptive to continuing talks with Medical Mutual.

Medical Mutual members may call (877) 328-6664 for information. Letters to members will be sent this week, Byers said.

Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com. Staff writer Lawrence Budd contributed to this report.

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Why bother having health insurance at all? This is outrageous. As soon as you get to know a doctor, your coverage changes and you end up having to go elsewhere. And now, as a Medical Mutual subscriber, I will have to drive at least 30 minutes to find a hospital that is considered to be "in network", instead of using the one ten minutes from my house at Upper Valley.

Sharon
12:52 PM, 12/14/2009

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Healthcare Insurance is NOT 20% of the economy. It is 35th on the top industries in the country behind Hershey, Beer, tupperware to name a few. A 2.2% profit is far behind the average.

RETIRED SGT
9:35 AM, 11/14/2009

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Yes, Ms. Pelosi is lying. So are the insurance companies. Health care is up to 20% of the economy. Even if they made 1% profit that would mean billions of dollars profit still. Not bad for a middle man. Ever seen the money that Med Mutual spent on their office in cleveland! The money they spend on sponsorship of professional teams. How about taking some of that money and sponsoring some of the hospitals that take care of indigent patients! Health insurance CEOs make millions in salaries.

Rad Doc
10:28 AM, 11/13/2009

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a 2.2% profit......

here's the story, of a lovely lady who's being lying right through her teeth (Pelosi)
http://www.youtube.com/watch?v=53wR...

further proof of misinformation by certain politicos:

http://apnews.myway.com/article/200...

RETIRED SGT
9:47 PM, 11/11/2009

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Health Insurance, contrary to popular belief, are not that profitable. What do these industries have in common? Yahoo, Hershey, Clorox, Molson/Coors brewing Co, Pizza hut, taco bell, farm machinery, Tupperware...They all made more profits than the typical healthcare company. In fact, healthcare on the average made 2.2% profit. Yet these corporations are being demonized by certain political groups as greedy. taco bell, beer, pizza make more in profits.

RETIRED SGT
9:41 PM, 11/11/2009

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