The ongoing contract dispute between Premier Health Network and Unitedhealthcare was one of the most significant local health care stories of 2017.
Negotiations between the region’s largest health care network and the insurance giant fell apart in May and now temporary extensions that eased some of the burden of the dispute are about to expire.
As of May, about 70,000 UHC-policy holders had used Premier services over the past 12 months.
The dispute centers around UnitedHealthcare’s plan to rank hospitals and doctors in tiers based on cost and quality, with the stated goal of lowering the cost of health care by encouraging patients to shop for cheaper care.
Patients pay lower co-pays with providers ranked as tier 1. None of Premier’s hospitals are in UnitedHealthcare’s tier 1, although some of its doctors are.
Premier opposes the ranking system, which it says steers patients away from its services and doesn’t accurately compare cost differences between its providers and other options.
Now local patients with UnitedHealthcare policies could be hit harder by the dispute in 2018 after temporary agreements that eased some of the burden of the dispute expire starting Jan. 1, like extended in-network coverage for Medicare Advantage plans and $25 co-pays.
As Jan. 1 nears, here’s a recap of the timeline of the contract dispute:
March 30: The Dayton Daily Newsreports Premier Health and UnitedHealthcare have reached an impasse during contract negotiations.
April 28: Premier Health and Unitedhealthcare agree to extended in-network coverage for UHC-managed Medicare Advantage plans until the end of 2017.
April 29: Premier Health’s hospitals — Miami Valley Hospital, Atrium Medical Center, Upper Valley Medical Center and Good Samaritan — are all out-of-network for UnitedHealthcare after its contract for individual and commercial health plans expires.
May 14: Premier Health’s physicians are no longer in-network for UnitedHealthcare employer-sponsored and individual plans. It’s contract for Unitedhealthcare-managed Medicaid plans also expires, leaving those members also out-of-network at its hospitals and doctors.
Oct. 15: Medicare open enrollment opens. Those with UHC-managed Medicare Advantage plans have until Dec. 7 to decide if they want to switch plans, switch doctors or pay more to see an out-of-network doctor.
Oct 16: Premier CEO Mary Boosalis sends a letter to patients urging them to switch insurance carriers from UnitedHealthcare during open enrollment season if they can, or to ask their employer to offer another option.
Jan. 1, 2018: Temporary agreements expire in January that had been letting patients with UHC pay Premier doctors with a $25 co-pay and let UHC-managed Medicare Advantage plans remain in-network with Premier.