UHC, Premier still out-of-network for Medicaid plans

UnitedHealthcare and Premier Health remain out of contract for the insurer’s 10,500 local Medicaid managed care policy holders.

Premier, the largest health care network in Southwest Ohio, had been out-of-network with UHC, the largest insurer in the U.S., for more than seven months before the two announced a new contract effective Jan. 1.

However, the agreements are only for its commercial insurance lines and Medicare Advantage plans and don’t include UHC’s Medicaid managed care plans, which contracts with Ohio Department of Medicaid to provide health care benefits for eligible low income residents and people with disabilities.

UHC said “while we have not reached an agreement on Medicaid, both organizations are committed to future discussions in an effort to reach a resolution.”

“Our negotiations have concluded at this time,” Premier stated. “However, UnitedHealthcare Medicaid members have had a range of enrollment alternatives for which Premier Health is in-network in 2018.”

Open enrollment season for Medicaid was from Nov. 1 to Nov. 30, when Medicaid enrollees could choose between five managed care plans, including UHC’s Community Plan.

On average, about 21 percent of patients at hospitals in the Dayton region are paying with Medicaid, according to the Greater Dayton Area Hospital Association.

CareSource is the largest Medicaid managed care provider and still has a contract with Premier. Kettering Health Network, the other large hospital and doctor network in the region, accepts UHC’s Medicaid managed care plan.

Premier also accepts Medicaid managed care plans with other insurers like Buckeye Health Plan and Paramount, as well as Aetna’s MyCare plan for dual Medicaid and Medicare enrollees. Premier doesn’t accept Molina.

Timeline: How Premier, UHC dispute unfolded in 2017

Residents with UHC’s Medicaid plans won’t be able to get in-network coverage at Premier’s hospitals and doctors, which includes Miami Valley Hospital and its second location at Miami Valley South, Atrium Medical Center, Upper Valley Medical Center and Good Samaritan.

Premier operates the only hospital in Miami County and the only hospital birthing centers in Dayton city limits.

The recently settled contract dispute between Premier and UHC had centered around the insurer’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 prompting patients to shop for cheaper care

Premier opposed the ranking system, which it said steered patients away from its services.

The two did not disclose if tiering was a part of the new contract they agreed on.

RELATED: High Medicaid, Medicare use in Dayton increases health care costs

UHC has 200,000 policy holders in the area and as of May, about 70,000 UHC-policy holders had used Premier services over the past 12 months.

While the two were out-of-network, Premier Health had said that its bottom line was off by “millions” because of UHC patients having their access curbed and UHC was challenged this open enrollment season with selling insurance policies that at the time couldn’t be used in-network at the largest health care provider in the region.

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