Prisma no longer in UnitedHealthcare insurance plans network


Prisma Health, South Carolina’s largest healthcare organization, is now out-of-network for UnitedHealthcare consumers after failing to negotiate an agreement by the end of the year.

After months of disagreeable negotiations, no agreement was reached.

Prisma Health charged UnitedHealthcare with failing to notice the “extraordinary inflationary cost” that the system is incurring. Prisma’s demand for a 24 percent price increase was deemed “outlandish” by UnitedHealthcare, who said the organization did not respond to their previous offering.

UnitedHealthcare issued the following statement:

“Prisma Health did not respond to our December 27 proposal and let our contract lapse.” Throughout our negotiation, Prisma maintained its demands for absurd price hikes that would have rendered its hospitals almost 25% higher cost than the Columbia and Greenville market averages and its physicians nearly 50% higher cost in those areas. While we remain open to continued negotiations should Prisma submit a proposal that’s affordable for consumers and employers, our focus now is on assuring South Carolinians have access to the care they need through either continuity of care or a seamless transition to a new provider.”

Prisma no longer in UnitedHealthcare insurance plans network

Prisma issued the following statement to Fox Carolina:

“As of Jan. 1, United Healthcare (UHC) has placed Prisma Health as out-of-network for its health plan members. We are in this predicament because UHC refuses to enter a reasonable arrangement that reimburses us for the cost hikes we have and continue to incur for their health plan participants.

Prisma Health has been able to come to agreements with every other major insurance company we have worked with throughout the past year because they recognized the additional costs that Prisma Health has incurred – all except UHC. This is merely another proof that Prisma Health is reasonable whereas UHC is not.

UHC notes a Dec. 27 proposal that was presented in response to Prisma Health’s proposal dated Dec. 26. As with previous proposals provided throughout our engagement, UHC demonstrated no good-faith movement in their last proposal and left the economics essentially unaltered. In our last communication to UHC on Dec. 30, we restated our intention to enter an agreement that would preserve Prisma Health in-network and requested them to present a realistic proposal. Because UHC refused to do so, Prisma Health was designated as out-of-network.

Prisma no longer in UnitedHealthcare insurance plans network

UHC continues to provide very false information concerning the sequence of events and the economics of the proposals that have been filed. Specifically, UHC continues to reference “near 20%” requested hikes over 12 months. This is absolutely not the case. Although it is our policy not to discuss specific specifics about our negotiations, Prisma Health’s requests to UHC have been less than 10% a year during a two-year timeframe.

In addition, we have recommended alternate reimbursement procedures that would decrease the rate impact on businesses. UHC has ignored their suggestions. Furthermore, Prisma Health has requested Medicare Advantage prices that are competitive in the market. UHC remains unwilling to sacrifice its personal profit margin and give proper payment rates for services we deliver to patients insured by UHC Medicare Advantage plans.

Patients with a UHC Medicare Advantage insurance policy who wish to continue to preserve 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 yearly Medicare Open Enrollment period runs Jan. 1 through March 31, 2024.”

UnitedHealthcare said some clients in the middle of treatment with a Prisma Health physician, such as pregnant women or patients in active cancer therapy, may be eligible for continuity of care.

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