LISA POWELL / STAFF

Premier, UnitedHealthcare negotiations continue over health plans

Contract negotiations between the region’s largest health system and insurer UnitedHealthcare remain at an impasse as a deadline approaches that could jeopardize the health plans of up to 70,000 local residents.

Premier Health and UnitedHealthcare, the area’s largest insurer, have been at an impasse in talks to renew their health coverage network relationships, and the deadline to reach an agreement on a contract is Saturday.

Area physicians and their offices are warning patients that they may have to make new arrangements, if an agreement isn’t reached.

A letter from the Hilltop OB/GYN offices warns patients, “We have just received notification that it does not look like an agreement will be reached by Premier and UHC, meaning Premier facilities (including Atrium Medical Center) will be out of network to you as of 4/30/17 (Sunday).”

“It’s unfortunate that the community needs to be put in the middle of this” said Scott McGohan, chief executive of Moraine-based insurance broker McGohan Brabender. “I think reasonable heads could come to a reasonable conclusion.”

Other area doctors are sending patients letters similar to Hilltop’s, advising patients to consider plans to contact other physicians not affected by Premier-United insurance network pacts.

The health insurer’s contract to cover care provided at Premier hospitals, physicians’ offices and urgent care facilities is set to expire for all lines of business, including employer-sponsored health plans, Medicare Advantage and Medicaid coverage, the company said.

UnitedHealthcare’s contract with Premier hospitals will expire Saturday for employer-sponsored and Medicare members, and on May 13 for Medicaid members.

On March 30, Premier officials said in a statement that they are confident they can get past any sticking point in the negotiations.

“We have nothing new to report at this time,” Ben Sutherly, a spokesman for Premier, said Monday.

UnitedHealthcare issued a statement which said: “Despite months of negotiations, Premier continues to make unreasonable demands that would diminish our employer groups’ ability to manage their health care costs more effectively through tiered benefit plans.

“Tiered benefit plans offer employers a means to provide competitive benefits while offering incentives to members in the form of lower co payments and coinsurance levels for choosing facilities who meet quality and cost efficient requirements,” the insurer’s statement said.

With just two significant competing hospital systems — Premier and Kettering Health Network, besides Children’s Medical Center — health care costs in the Dayton area are “significantly higher” than costs in Cincinnati and Columbus, larger cities that have more health care market competition, McGohan said.

“We need to address the cost of health care,” McGohan said. “And United has taken a stance and (said), ‘This is not our money; this is our employers’ money.’ And I don’t disagree with that.”

McGohan Brabender serves employers, helping them navigate regional health care costs and providers.

“Cincinnati might have five (health care and hospital) systems that wake up every day and compete,” McGohan said. “Columbus has five systems that wake up every day and compete. Dayton only has two, and it has three with Children’s Medical Center.”

There are unique dynamics in the Dayton region that differentiate us from other cities of similar or larger size, Premier said in a statement.

“First, Dayton does not have a safety net hospital, such as a county or university facility where unreimbursed care is funded by government dollars. This is significant; Miami Valley Hospital, for example, is the third largest Medicaid provider in the state of Ohio. In addition, Premier Health provides significant support for local medical education. In other cities, such education is supported by state tax dollars,” the statement continues.

Hilltop’s letter to patients assures “established pregnant patient(s) with Hilltop” who will be 13 or more weeks pregnant by Sunday (April 30) that they can remain with Hilltop and deliver at Atrium Medical Center in Middletown with a prior authorization, which the office says it will obtain for those patients.

For patients who are less than 13 weeks pregnant by Sunday, the office tells those patients they will not be able to deliver at Atrium.

“We currently do not deliver at any other facility, but will be looking into options for you,” the letter adds. “We will be in touch directly with those of you directly effected by this.”

X