» If Premier and UHC can’t reach an agreement, physicians employed by Premier will be out of network at midnight Saturday for UHC members with employer-sponsored and individual health plans, as well as those with UHC-managed Medicaid plans.
» Seniors with UHC Medicare Advantage plans are OK. The two sides agreed late last month to extend their network relationship for UHC Medicare Advantage plans through the end of the year, providing policyholders with uninterrupted access to Premier hospitals and physicians.
RELATED: Premier, UnitedHealthcare still open to negotiations
WHAT ARE THE CHANGES?
» Premier hospitals are already out of network for UHC members with employer-sponsored and individual plans because the two sides couldn’t reach agreement on their hospital contract by April 29.
HOW MANY PEOPLE ARE AFFECTED?
» About 70,000 Dayton area residents are enrolled in UHC health plans.
WHY IS THIS HAPPENING?
» The main issue in the contract dispute is UHC’s new health plan design, which ranks hospitals and providers in tiers based on cost and quality. Premier argues it would be inherently disadvantaged by the tiered system, which, Premier says, would also limit consumer choice. UHC argues the plan design encourages consumers to choose the most cost-efficient care providers, helping to drive down health costs for consumers in the long run.
RELATED: 5 things to know if you’re UnitedHealthcare member
WHAT’S NEXT?
Failed contract negotiations would leave thousands of UHC policyholders scrambling to find new in-network providers in the Dayton area, although UHC was quick to point out that it will continue to offer a broad network of participating hospitals in southwest Ohio, including:
•Dayton Children’s Hospital
•Grandview Hospital
•Greene Memorial Hospital
•Kettering Medical Center
•Medical Center at Elizabeth Place
•Soin Medical Center
•Southview Hospital
•Springfield Regional Medical Center
•Sycamore Medical Center
RELATED: Premier Health, UnitedHealthcare at odds over health plans
REACTIONS FROM BOTH SIDES:
“At Premier Health, we want to reach a reasonable contract with UnitedHealthcare as soon as possible to minimize disruptions for our patients. However, we don’t want that resolution to come at the expense of patient choice,” Premier said in a statement.
“As one of the most expensive health systems in Southwestern Ohio, Premier continues to make demands that would prevent employers from giving their workers incentives for choosing quality, cost efficient care providers and instead, insists on continuing to drive up costs for the community,” UHC stated.
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