No deal between UHC and Premier, but certain conditions still covered

UnitedHealthcare will still cover a few conditions at Premier Health hospitals, a spokesman for the insurance agency said on Monday.

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UnitedHealthcare will still cover a few conditions at Premier Health hospitals, a spokesman for the insurance agency said on Monday.

Some patients insured by UnitedHealthcare may still be able to go to Premier Health hospitals, even though the two are at odds over a contract agreement.

Premier Health and UHC failed to reach a contract deal by last weekend’s deadline, meaning close to 70,000 with UHC plans can’t use their insurance at Premier hospitals or doctors offices. Many UHC policy holders will now have to find new in-network providers in the Dayton area.

RELATED: Q&A on Premier Health, UnitedHealthcare contract dispute

But, people with a few medical conditions may still be able to get treatment at Premier hospitals through something called “continuity of care,” said Anthony Marusic, UHC spokesman. Pregnant women in their second or third trimester, people recently diagnosed with cancer or receiving cancer treatment and organ transplant recipients or candidates may qualify for continuing coverage.

UHC members with a medical condition they think qualifies can apply for "continuity of care" online. It will take between 10 and 15 days for people to be approved for the program, according to UHC.

“We are working directly with our members who may have ongoing health concerns or may be in the middle of a treatment at a Premier Health facility or with a Premier physician to ensure appropriate accommodations are made to avoid disruption in their care,” Marusic said in an email.

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The final deadline for Premier Health to settle is contract dispute with Minnesota-based health insurer, UnitedHealthcare, is midnight Saturday.

Credit: DaytonDailyNews

Seniors with UHC Medicare Advantage plans have been shielded from the contract dispute. 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: What you need to know if you have a UnitedHealthcare plan

The main issue in the contract dispute was 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.

The contract talks are expected to impact surgeries some patients may have scheduled, though UHC is encouraging its members to see if their procedure could still be covered under the insurer’s continuity policy. Premier Health schedulers are contacting some patients to cancel surgeries unless they were authorized to proceed, said spokesman Ben Sutherly.

Technically, all patients covered by UHC could still seek treatment at Premier facilities but they would “incur significantly higher out-of-pocket expenses,” Sutherly said.

The dispute will not affect people in need of emergency care, spokesmen from both companies said. If someone is in a car accident, they will still be covered and should go to the nearest hospital, even if it’s a place that is “out of network.”

Premier Health operates Miami Valley, Miami Valley South and Good Samaritan hospitals and Upper Valley and Atrium medical centers.

RELATED: 5 things to know about Premier Health, UHC contract dispute

An agreement remained out of reach for UHC and Premier as of Monday. While both UHC and Premier said they are open to trying to resolve their disagreements, Premier called the dispute an “upheaval” for UHC members.

Premier offered to forgo a rate increase for 2017 but UHC rejected the offer, Sutherly said. Any contract needs to provide quality, affordable health care, Marusic said.

“Premier Health remains committed to resolving our differences with UnitedHealthcare as soon as possible while protecting patient choice,” Sutherly said via email. “We continue to keep the lines of communication open out of great concern for our patients.”

Premier and UHC likely won’t bring a mediator in to try to further negotiate, said Mark Shaw, Premier vice president of managed care. While the contract offer Premier made to UHC was similar to agreements made recently with other insurance providers, Shaw said they will “work as long as it takes” to reach a deal.

“I think we’re trying to do what’s right for our community,” Shaw said. “We’re here, we live here. Premier is community owned and our board is our community people so we have to look out for our enrollees.”

Patients can visit Kettering Health Network hospitals and physicians if they have UnitedHealthcare plans. Kettering Health operates Grandview, Greene Memorial and Southview hospitals, and Kettering and Soin medical centers. United Healthcare patients who need assistance with any of Kettering Health physicians and services can call 1-888-847-5713.

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The Dayton Daily News is your only source for the latest updates on negotiations between Premier Health and UnitedHealthcare. Count on us to continue our in-depth coverage on the issue.

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