Premier physicians would be out-of-network on May 14 for employer-sponsored, individual, Medicare Advantage and Medicaid plans, according to UHC. And both Premier hospitals and physicians would be out-of-network for Medicaid plans starting May 14, if an agreement is not reached.
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All toll, about 70,000 residents would be impacted in the local area, according to UHC, which said Premier’s decision not to participate in the insurer’s plan design, which ranks hospitals and providers in tiers based on cost and quality, was the sticking point in their negotiations.
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But in an interview Thursday with the Dayton Daily News, Premier Health President and CEO Mary Boosalis said the “tiering” system would intentionally steer patients away from Premier providers, even after the health system has agreed to offer UHC discounts on the providers’ services in exchange for the additional patient volume the health plan can offer.
“We believe they want the volume for discount while at the same time the ability in the contract to direct or steer patients via a tiering mechanism toward a different rate,” Boosalis said. “Thereby, United would have the advantage for certain services of a discounted volume rate, but at the same time be able to direct people away from us after we’ve agreed to this rate.
“We want a deal with UnitedHealthcare,” she said. But “why have a contract if there’s only a win for one party. A good contract needs to be a win-win for both, and ultimately for the patient.”
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UHC said in a statement Thursday that it would continue to work with Premier to reach a deal, but added: “Premier does not believe local employers should be allowed to give their workers incentives for choosing high quality, cost efficient care providers. As one of the most expensive health systems in Southwestern Ohio, Premier insists on a new contract that would prevent local residents from being rewarded for making informed health care choices. We believe consumers should ultimately be in control of deciding whether they want to use a more costly hospital for their care, rather than these choices being taken away from them.”
If an agreement can’t be reached, some UHC members may be able to continue receiving care at Premier’s hospitals or physician groups with in-network coverage for a period of time if the contract expires, the health insurer said. Those members would include pregnant women or those undergoing active treatment for a serious medical condition, such as cancer.
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To determine eligibility, members can call the customer service number on their health plan ID card, according to UHC.
In the event of an emergency, UHC is advising its members go to the nearest hospital because emergency services will be covered as an in-network benefit regardless of the hospital’s participation status in UnitedHealthcare’s network.
“We understand it can be disruptive to our members when a hospital or physician group decides to stop participating in our network, and we are focused on making sure our members have continued access to care should a transition in care be needed,” UHC said in a statement.
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