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.
About the Author