United Healthcare Drops Prisma from Network: Key Changes

TL/DR –

Prisma Health and United Healthcare have failed to agree on a new contract, causing thousands of patients to be out-of-network at Prisma Health facilities. The two companies have been negotiating for months but cannot agree on the amount United Healthcare should reimburse Prisma for its services. United Healthcare claims Prisma has demanded a 20% price hike for employer-sponsored plans, leading to increased costs of nearly $60 million for employer-sponsored plans and $17 million for Medicare Advantage plans over two years, while Prisma states the increase request is less than 10% over two years.

Prisma Health Facilities Now Out-of-Network for United Healthcare Patients

Prisma Health and United Healthcare failed to reach an agreement, leaving thousands of patients out-of-network at Prisma Health facilities. The two giant health firms were engaged in contract negotiations for months, with reimbursement of Prisma’s services being the primary contention point.

United Healthcare services numerous employer-sponsored healthcare plans in the Upstate (including UMR). Despite the fallout, these customers can still seek medical assistance from Bon Secours St. Francis, AnMed, Spartanburg Regional, and other providers in the United Healthcare network.

United Healthcare stated that customers pregnant in their second or third trimester, as well as those newly diagnosed or undergoing cancer treatment, might qualify for continued care at Prisma facilities.

The impasse has left customers scrambling to figure out their healthcare needs while the two companies blame each other for the loss of coverage. Prisma Health claimed UHC’s refusal to enter a reasonable agreement that accommodates cost increases they’ve absorbed for UHC members as the main issue.

Conversely, United Healthcare accused Prisma Health of demanding a 20%-plus price hike for employer-sponsored commercial plans over the next year. They claim Prisma’s proposal would hike healthcare costs by nearly $60 million, unaffordable for South Carolinians and employers. Furthermore, they allege Prisma is seeking significant rate increases for Medicare Advantage plans, amounting to nearly $17 million over two years.

Prisma rebuffed such claims, maintaining their actual increase request is less than 10% over two years. Both companies are continuing to negotiate, each asking the other for “reasonable” proposals to establish a contract.

Find United Healthcare’s full statement on their website.

Prisma Health’s Full Statement:

“As of Jan. 1, United Healthcare (UHC) has placed Prisma Health as out-of-network for its health plan members. We are in this situation because UHC refuses to enter a reasonable agreement that reimburses us for the cost increases we have and continue to absorb for their health plan members….. UHC’s last proposal showed no good-faith movement and left the economics largely unchanged. …Although it is our policy not to disclose specific details about our negotiations, Prisma Health’s requests to UHC have been less than 10% a year over a two-year timeframe. …Patients with a UHC Medicare Advantage insurance policy who want to continue to keep their relationships with the doctors they trust have options by switching to a plan that includes Prisma Health as in-network during the annual open enrollment period. The annual Medicare Open Enrollment period runs Jan. 1 through March 31, 2024.” – Prisma Health

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