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Make Your Voice Heard

To UnitedHealthcare Members From Premier Health:

Mary Boosalis HeadshotWe are writing to you out of concern over recent events that have left Premier Health out of network with UnitedHealthcare (UHC). As you may know, this affects thousands of members of our community, significantly limiting their health care choices. As a mission-driven health system, we are particularly disappointed that UHC decided to take this action in mid-year, leaving many of you in a very stressful position.

As members of the local community ourselves, we care deeply about our patients, staff and physicians and have done so for more than 125 years. To make every effort to come to an agreement, we made an offer to extend our commercial contract with UHC, forgoing a nominal increase in rates through the end of the year. UHC rejected our proposal. We made this offer so that our patients would not experience any inconvenience and could then make choices during the normal open enrollment period later this year. By rejecting our offer, UHC has effectively taken away choice from you and your employer as to where to access health care services. Very importantly, their decision will result in separating patients from long-standing relationships with their physicians.

This is not a rate issue. It is about assuring that you have a choice in where you receive your health care. The sticking point is a tiered benefit design and according to UHC, would only have applied to a very small segment of its 200,000-member base. Instead, UHC chose to put the remainder of their members, who access service with Premier Health, in the middle of a contract issue.

We are, however, pleased to report that Premier Health and UHC have extended the contract for Medicare coverage through the end of the year. We have had questions about which products this applies to. Because UHC sells many Medicare products, it would be safe to say that if the word “Medicare” is in your plan name, you are covered, but you may want to confirm this with UHC. Below you will see contact information for you to call with any questions.

We remain open to keeping the lines of communication open with UHC to resolve these issues for our patients as soon as possible. In the meantime, we encourage you to contact UHC at (800) 537-2977(800) 537-2977 to express your concerns. If you have questions of us, please call (866) 270-0807(866) 270-0807.

Our commitment to our local community—including all of you—remains steadfast and serving you is our privilege and our mission.

Sincerely,

Mary Boosalis
President and Chief Executive Officer
Premier Health

Frequently Asked Questions

What is happening?

Premier Health and our patients are facing the unfortunate situation that our hospitals and sites of service are no longer participating providers and facilities with UnitedHealthcare’s commercial insurance plans as of Sunday, April 30, 2017, and that our employed physicians will be out-of-network starting on May 14, 2017.

Why is this happening?

In our opinion, UnitedHealthcare is jeopardizing the health coverage of the vast majority of its 200,000 local members in an attempt to gain leverage in contract negotiations with Premier Health.

What’s the sticking point?

We are very concerned that, in our opinion, UnitedHealthcare’s “tiered” benefit design strategy effectively takes away a patient’s right to choose providers. Premier Health believes strongly that all UnitedHealthcare members should have equal choice when selecting between in-network providers.

What is tiering?

Let’s take a hypothetical example. Assume that a surgery costs $6,000 at a Premier Health hospital and $5,000 at another hospital.

Now, let’s say that the patient is responsible for paying 20 percent of that cost out-of-pocket. That would mean the patient would owe $1,200 in out-of-pocket costs for the hypothetical Premier Health surgery, and $1,000 in out-of-pocket costs for the surgery at the other hospital.

With tiering, UnitedHealthcare would raise the patient’s out-of-pocket responsibility for seeking care at a Premier Health hospital to 40 percent or more of the cost of those services.

This would increase the patient’s out-of-pocket costs to $2,400 for surgery at the Premier Health hospital, whereas the patient would still owe $1,000 for surgery at the other hospital. Instead of the $200 difference in out-of-pocket responsibility between hospitals as it exists in the current benefit design, with a tiered benefit design the patient would be on the hook for a $1,400 difference, and would be far more likely to consider receiving care elsewhere.

What is Premier Health doing to fix this?

We are doing all that we can for our patients. We are open to finding a negotiated solution so that our patients aren’t put at risk and can choose the doctor and the care that they want and deserve. In fact, we have offered United Healthcare the option of reinstating the existing contract and extending it through the end of the year so that companies and employees can make their choice of providers during annual enrollment. It is our sincere hope that UnitedHealthcare agrees and will work with us in good faith to reach a meaningful solution to minimize the disruption in health coverage for so many of its members.

What will this mean for UnitedHealthcare Commercial Plan Members?

UnitedHealthcare Commercial Plan members will be able to access emergency care at the closest hospital, including out-of-network Premier Health hospitals, as they currently do. However, they should be aware of the ramifications of using out-of-network services, as it is possible that they might be responsible for a portion of the bill.

In addition, expectant mothers and cancer patients who are currently receiving treatments can pursue continuation-of-care authorizations from UnitedHealthcare, to get authorization to continue receiving that care from their Premier provider. For other care, UnitedHealthcare Commercial Plan members will need to contact UnitedHealthcare to find an alternative, in-network provider.

What will this mean for UnitedHealthcare Medicare members?

UnitedHealthcare’s Medicare members are not currently impacted by this issue. Premier facilities and providers will continue to remain in-network with UnitedHealthcare’s Medicare products through the remainder of this benefit year.

Why is Premier Health taking this stand?

We share the concerns of our local neighbors who would be significantly affected if Premier Health’s facilities are no longer participating providers and facilities with UnitedHealthcare’s commercial plans. In our opinion, it is irresponsible for UnitedHealthcare to interrupt the coverage of local residents and to effectively force patients to switch coverage or providers (and to do so mid-year) while they are receiving care. We are also concerned that, in our opinion, a national health insurance company is jeopardizing the health care coverage of tens of thousands of local residents to try to force a local health care provider to participate in its “tiered” benefit design, which is a small, unconventional insurance option.

Content Updated: May 8, 2017

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