5 things to know if you have a UnitedHealthcare plan


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5 things to know if you have a UnitedHealthcare plan

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Failed contract talks mean most Dayton-area residents with individual or commercial health plans from UnitedHealthcare no longer have access to hospitals in the Dayton-based Premier Health network, including Good Samaritan Hospital, pictured here. PHOTO/PROVIDED

Premier Health and UnitedHealthcare failed to reach agreement over the weekend on a contract that would extend coverage for the giant health insurer’s individual and commercial health plan members at Premier hospitals.

Both sides said they remain open to negotiations to restore access to the Dayton-based hospital network’s facilities and to avoid a coverage interruption for tens of thousands UnitedHealthcare members who visit Premier hospitals and physicians.

In the meantime:

• Premier Health hospitals, including Miami Valley Hospital, Miami Valley Hospital South, Atrium, Good Samaritan Hospital and Upper Valley Medical Center, are now out of network for UnitedHealthcare members with employer-sponsored and individual plans.

• Premier Health physicians will remain in-network through May 13 for employer-sponsored and individual plans. But if an agreement on the physician contract is not reached, Premier physicians will be out of network beginning May 14. In addition, Premier Health hospitals and physicians will be out of network for UnitedHealthcare members with Medicaid plans starting May 14 if an agreement is not reached.

• UnitedHealthcare individual and commercial health plans members still have access to Dayton-based hospitals. Available are:

— Dayton Children’s Hospital

— Grandview Hospital

— Greene Memorial Hospital

— Kettering Medical Center

— Medical Center at Elizabeth Place

— Soin Medical Center

— Southview Hospital

— Springfield Regional Medical Center

— Sycamore Medical Center

• Some UnitedHealthcare members may be able to continue receiving care at Premier’s hospitals or physician groups network coverage for a period of time, such as members who are pregnant or undergoing active treatment for a serious medical condition, such as cancer. UnitedHealthcare members have been advised to contact the insurer to determine their eligibility.

• Even though the hospital contract has expired, Premier and UnitedHealthcare have agreed to extended their network relationship for UnitedHealthcare Medicare Advantage plans, providing beneficiaries uninterrupted access to Premier hospitals and physicians through Dec. 31, 2017.

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