UnitedHealthcare, Prisma fail to reach agreement

When Celeste Evans received an email a few months ago notifying her UnitedHealthcare would no longer be in network with Prisma Health unless they could reach new negotiations before January, she was told not to panic. After all, both companies told her negotiations were still ongoing and it was likely they would reach an agreement before January.

It was not until last week she began receiving phone calls from doctors’ offices, she had appointments scheduled with, who informed her she was out of network.

“They all reached out to me to tell me I was out of network, and I was going to have to pay out of pocket,” Evans said. “One test was $2,200.”

Evans, who sees six doctors at Prisma Health, called other doctors to make a new patient appointment. Unfortunately, she was told most doctors do not see new patients without a three to sixmonth waiting period.

After months of negotiations, Prisma Health and UnitedHealthcare (UHC) have been unable to agree and secure a negotiation – meaning UHC patients will no longer be in network with Prisma Health.

Both healthcare companies blame each other, with Prisma alleging they are “in this situation because UHC refuses to enter a reasonable agreement that reimburses us for the cost increases we have and continue to absorb for their health plan members.”

UHC claims Prisma requested a “nearly 20% price hike,” saying if it were to take place, it would increase healthcare costs by almost $50 million. UHC also stated Prisma “sought significant rate increases for our Medicare Advantage plans that would have increased health care costs by $16 million.”

In its statement, Prisma says it “has been able to come to agreements with all other major insurance companies negotiated with during the past year,

recognizing the increased costs that Prisma Health has incurred – all except UHC. This is just more evidence that Prisma Health is being reasonable, but UHC is not.”

Prisma also denies the reference to an almost 20% price hike.

“Although it is our policy not to disclose specific details about our negotiations, Prisma Health’s requests to UHC have been less than 10% a year over a two-year timeframe,” Prisma’s statement said.

Months of negotiation between Prisma, UHC

In UHC’s statement, the insurance company referred to a lawsuit filed by Prisma Health in August requesting a motion for an injunction.

In the lawsuit, Prisma alleges UHC made “inflammatory and inaccurate statements to various media outlets regarding the parties’ private business relationships.”

It also states “United’s media statement regarding Prisma’s alleged recent counterproposal was false or materially incorrect, and United intentionally made the statement knowing that it was false or materially incorrect. United’s media statement regarding Prisma’s alleged recent counterproposal was false or materially incorrect, and United intentionally made the statement knowing that it was false or materially incorrect.”

In UHC’s response, it says Prisma sent an email in August informing patients Prisma Health would no longer be in network with UHC, which prompted a reporter to ask for a statement from UHC regarding the situation. UHC says in its statement, “described the aggregate net financial impact of the price increases Prisma had insisted on in the ongoing negotiations with United. United did not disclose any ‘specific reimbursement amounts.’”

A judge eventually dismissed Prisma’s motion for an injunction.

What this means for patients

A spokesperson with UHC told Greenville News that 58,000 members combined received services from a Prisma provider over the past 12 months.

Patients can switch to a plan that includes Prisma Health in its network. Some patients, such as pregnant women or those actively being treated for cancer, may be eligible for continuity of care.