Premier Health now out-of-network for UnitedHealthcare plans

Credit: DaytonDailyNews

Final deadline looms for UHC and Premier Health negotiations

Credit: DaytonDailyNews

A deadline has passed, which means that Dayton-based Premier Health Network is no longer participating in UnitedHealthcare’s network for employer-sponsored, individual and those with UHC-managed Medicaid plans.

Starting today May 14, all Premier hospitals and physicians are considered out-of-network for these plans.

UnitedHealthcare has issued an updated statement about Premier’s decision.

“Despite repeated efforts to reach a compromise, all of Premier Health Network’s proposals maintained their position as one of the most expensive health systems in Southwest Ohio and demanded local businesses be restricted from offering competitive benefits that put consumer choice first and allow workers to be rewarded for choosing quality, cost efficient care providers.

“UnitedHealthcare’s goal remains to find an acceptable solution that would renew in-network access to Premier’s hospitals and physicians with a contract focused on quality, affordable health care that preserves consumer choice.”

Seniors with UHC Medicare Advantage plans are not affected by the change. The two sides last month agreed to extend their network relationship through the end of the year.

About 70,000 Dayton area residents are enrolled in UHC health plans.

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, also would 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.

Failed contract negotiations mean thousands of UHC policyholders need 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
  • Fort Hamilton 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
  • Ohio Valley Surgical Hospital