UnitedHealthcare, Prisma Health split

UnitedHealthcare and Greenville, S.C.-based Prisma Health went out of network Jan. 1 after the two sides failed to reach a new agreement. 

The 18-hospital system is out of network for UnitedHealthcare commercial and Medicare Advantage plans, according to a Dec. 20 statement from UnitedHealthcare. 

In a statement shared with Becker's Jan. 2, a Prisma Health spokesperson said UnitedHealthcare refused "to enter a reasonable agreement that reimburses us for the cost increases we have and continue to absorb for their health plan members."

"Prisma Health has been able to come to agreements with all other major insurance companies we have negotiated with during the past year because they recognized the increased costs that Prisma Health has incurred — all except UHC," the spokesperson said. "This is just more evidence that Prisma Health is being reasonable, but UHC is not." 

A UnitedHealthcare spokesperson told Becker's the system "maintained demands for outlandish price hikes," which would raise costs for hospitals and physicians higher than market averages. 

"While we remain open to continued discussions should Prisma provide a proposal that's affordable for consumers and employers, our focus now is on ensuring South Carolinians have access to the care they need through either continuity of care or a seamless transition to a new provider," the spokesperson said. 

Prisma Health requested a nearly 20% rate increase for employer-sponsored plans over two years, the UnitedHealthcare spokesperson said. In its statement, Prisma Health said its proposed rate increases are below 10% over two years. 

"UHC continues to use very misleading information about the sequence of events and the economics of the proposals that have been submitted," Prisma Health said. 

Prisma Health filed a request for a restraining order against UnitedHealthcare in August, alleging the insurer broke its confidentiality agreement by disclosing details of contract negotiations to the media without Prisma's knowledge. The judge sided with UnitedHealthcare, denying the request. Prisma filed an appeal in November. 

UnitedHealthcare members in the middle of treatment with a Prisma provider or with serious acute or chronic conditions may be eligible for continuity of care, allowing them to continue receiving covered services at Prisma, the UnitedHealthcare spokesperson said. 

UnitedHealthcare Medicare Advantage members who want to continue receiving in-network care at Prisma can switch to a new plan through an insurer that is in-network with the system through March 31, the health system said in its statement. 

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