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Public retirees affected by Medical Mutual-Premier split

Hospital care benefits for thousands of area residents will be affected.

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By Ben Sutherly, Staff Writer 10:42 PM Tuesday, November 17, 2009

DAYTON — Edward and Ginger Seamon of Middletown took pride in the new Atrium Medical Center in Warren County, volunteering there regularly.

But the Seamons — he a retired principal and she a retired teacher — now find themselves in a fix: After Jan. 1, should they need hospitalization, they can’t be admitted at Atrium without paying cost-prohibitive, out-of-network rates.

That’s because Medical Mutual of Ohio said last week it’s terminating its agreement with Premier Health Partners, whose hospitals include Miami Valley and Good Samaritan hospitals, Upper Valley Medical Center and Atrium. Medical Mutual said it won’t accept Premier’s proposed reimbursement rates.

“It’s very ironic that we can’t use it (Atrium),” Ginger Seamon said. She and her husband, who is about to receive a volunteer service award from the hospital, plan to stop volunteering there at year’s end.

The Seamons aren’t alone. Public-sector retirees throughout the Dayton region will be affected if Premier Health Partners is no longer part of Medical Mutual’s network.

In 2010, a Medical Mutual plan is the only option available for State Teachers Retirement System retirees 65 and older not enrolled in Medicare parts A and B, as well as for retirees under 65, STRS spokeswoman Laura Ecklar said. (The Seamons don’t have Medicare part A).

The impact will be felt primarily in retirees’ access to hospitals, not doctors, Ecklar said.

Ecklar couldn’t say how many STRS beneficiaries would be affected by the pending Medical Mutual-Premier rift.

The Ohio Public Employees Retirement System, meanwhile, has 2,393 beneficiaries in the Dayton area that use the Premier hospital network, OPERS spokeswoman Julie Graham-Price said. The majority of them are not Medicare-eligible, meaning they’re under 65 years old.

Beneficiaries of the Ohio Police and Fire Pension Fund are not affected; their benefits are administered by UnitedHealthcare, a fund spokesman said.

Medical Mutual is also the sole third-party administrator for Upper Valley Medical Center’s health plan. The looming rift affects 1,120 employees there.

Medical Mutual members may call (877) 328-6664 for information.

Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com.

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I called Medical Mutual and was told that ATRIUM MEDICAL CENTER will still be accepting Medical Mutual insurance. The rep I talked with said it was Dayton hospitals (Montgomery County) that will no longer be accepting Medical Mutual. Somebody needs to get their facts straight.

Jenni Beckner
7:12 PM, 11/29/2009

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Jack,
‘Minds are like parachutes — they only function when open.’

Jim
6:21 PM, 11/18/2009

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Well left wing nut job. Talk about ignoring the facts. There are NOT 45 million un-insured. It's closer to 15 million. So you want to ration health care for 300 million so 15 million can have rationed health care too? Does that seem dumb to you? You have no analytical abilities at all. All you have is an emotional argument. And you ignore any facts that get in the way of those emotions. I think that's just pathetic. You want the majority to suffer so a few will benefit. Amazing!

Jack
3:47 PM, 11/18/2009

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Jack,
Facts please. Where in the bills being discussed does it mention anything about rationed health care? I want to know where you're getting this from. You call us wing nuts, yet you're the one making these wild claims based on nothing but you're misinformed, unread, uneducated opinion. And Jack, do you really believe anything Dr.No (Tom Colburn) says? He even voted against increasing Veteran benefits the other day. Colburn is bought and paid for by the insurance lobby. RESEARCH IT!!!

Jim
3:17 PM, 11/18/2009

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Please Jack. Why can't you grasp that this isn't about left or right, its about our broken health care system. WE ALREADY RATION HEALTH CARE JACK. I bet the 45 million uninsured think that we ration health insurance. I bet that the millions who are denied coverage for procedures that the insurance company says aren't necessary or are too expensive think that health care is rationed. RESPOND JACK.
http://www.latimes.com/news/opinion...,0,4716464.column

Jack-Ignores-Facts
3:14 PM, 11/18/2009

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