Spotlight FAQ Premier Health - UnitedHealthcare 2018 Agreement

Premier Pulse     January 2018

Premier Health and UnitedHealthcare (UHC) reached an agreement for Premier Health to be in-network for UHC Medicare and commercial products effective January 1, 2018.

Which products are affected by the contract between Premier Health and UHC?

  • All UHC Medicare products – Premier Health hospitals and physicians are in-network.
    • Here are names of the more common UHC Medicare plans:
      • AARP Medicare Complete (All Plans)
      • UnitedHealthcare Connected (All Plans)
      • UnitedHealthcare Dual Complete (All Plans)
      • UnitedHealthcare Group Medicare Advantage (All Plans)
      • UnitedHealthcare MedicareComplete (All Plans)
      • UHC/AARP Medicare Supplemental Plans (All Plans)
  • All UHC Commercial products – Premier Health hospitals are in-network for all commercial plans, including plans administered by UMR (United Medical Resources), Golden Rule, and other third-party administrators who utilize UHC for their network.
  • UHC Medicaid products – Premier Health hospitals and physicians are NOT contracted with any UHC Medicaid products. If a patient has UHC-Medicare or traditional Medicare primary, and UHC Medicaid secondary, they can be treated in-network based on their primary coverage. UHC Medicaid patients can be referred to UHC Medicaid to find in-network providers, which include Kettering Health Network and Community Health Centers of Greater Dayton.

What about tiering and limited patient choice?

Consistent with Premier Health’s position throughout the negotiations, the health system does not participate in any tiered products offered by UHC. Our approach protects patient choice, so they have an equal choice in utilizing Premier Health when they select a health plan that includes Premier Health in-network. Tiered products represent a very small portion of UHC’s business, and we do not expect such products to grow in the future.

What if UHC Medicaid is my secondary insurance?

If a patient’s primary insurance is a contracted plan with Premier Health, they should continue to utilize Premier Health.

What about United Behavioral Health or Optum Health?

United Behavioral Health (UBH), now known as Optum Health, is a division of UnitedHealth Group but is not part of the UnitedHealthcare insurance plan, nor part of the UHC contract. The UBH/Optum contract is separate and was not affected by the 2017 negotiation.

How long does the contract last?

The contract between Premier Health and UHC lasts until March 31, 2021. Premier Health’s current contracts with other major plans, including Anthem, Aetna, Medical Mutual, Cigna, and Humana, will last through 2019 or 2020, depending on the contract.

Does this affect 2017 patient accounts that were processed out-of-network?

The 2017 out-of-network claims will continue to be billed and collected consistent with Premier Health’s processes for out-of-network collections.

Is Premier Health communicating with patients about this change?

Premier Health has implemented a variety of communication tactics with patients, such as letters, social media, advertisements and other communication methods, to inform UHC members that they can utilize Premier Health as in-network again. If you know anyone with UHC coverage, please personally let them know of the contract change. Many UHC members changed plans during open enrollment, so if you know anyone who changed, also be sure to thank them for doing so. It remained uncertain whether Premier Health and UHC would reach an agreement as late as December 31, so employers and patients who changed from UHC were prudent in making that decision.

If a previous UHC member changed plans during open enrollment, can they change back to UHC?

Medicare beneficiaries cannot change plans until open enrollment in fall 2018. If a UHC Medicare member in 2017 changed to a different contracted plan for 2018, they can continue to utilize Premier Health in-network through that other plan and decide for the 2019 year whether to consider UHC Medicare once again.

Commercial members who typically receive their insurance coverage through an employer are unlikely to be able to change plans outside their normal open enrollment period. If they changed to a different plan such as Anthem, Aetna, Medical Mutual, Humana, or Cigna, they can be confident that Premier Health is in-network with that plan for years to come. During their next open enrollment period, which can vary by employer, they can evaluate the benefits of their different plan options.

UHC Medicaid members are still out-of-network with Premier. If they want to change to a contracted plan (CareSource, Paramount or Buckeye), they would need to do so during the next open enrollment period.

When I or a patient calls UHC, they still show a Premier Health site or physician as out-of-network. What does that mean?

UHC is in the process of re-loading all of the Premier Health hospitals and physicians in their system, and all claims from dates of service January 1, 2018 and forward will be processed as in-network (excluding UHC Medicaid since UHC Medicaid is not contracted). If a UHC phone representative or system shows Premier Health as out-of-network, disregard that information and allow more time for UHC to finish updating their systems.

EPIC payer information also shows Premier Health as out-of-network with UHC. Why is that?

Premier Health also is updating all the necessary systems that might have previously listed UHC as out-of-network. For all UHC Medicare and commercial patients, you can be confident that Premier Health is in-network with UHC for 2018. 

Back to the January 2018 issue of Premier Pulse

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