UnitedHealthcare, Prisma Health divided on contract impasse

As UnitedHealthcare and Greenville, S.C.-based Prisma Health continue to spar over renewing contracts, the parties' accounts of the negotiation process are also divided.

Prisma Health announced that a deal has not been reached and told patients that Upstate hospitals and physicians will be out of network effective Jan. 1, 2022, according to a cached version of its website from Nov. 4. 

Hospitals in the Midlands will be out of network effective March 1, 2022, with the exception of Prisma Health Tuomey Hospital, which will be out of network April 1, 2022, Prisma said. 

Affected plans include UnitedHealthcare's Medicare Advantage and employer-sponsored health plans, VA Community Care Network, United Behavioral Health and Spectera Eyecare Network plans, according to Prisma.

While Pisma did not directly respond to Becker's request for comment, the provider has since updated its website to reflect negotiations that it says are continuing with UnitedHealthcare. 

"For several months, Prisma Health has been working in good faith with UnitedHealthcare to renew our payor contracts for hospital and physician services," the website said. "Despite our efforts and diligence, we have been unable to come to an agreement. Prisma Health is continuing to negotiate with UnitedHealthcare in the hope of reaching new agreements that will allow UnitedHealthcare members to maintain in-network access to the Prisma Health hospitals and physicians they depend on for local, high-quality care; but it is not certain this will happen."

UnitedHealthcare contested Prisma Health's claims. A spokesperson told Becker's that the parties had reached a verbal agreement on rate increases, but after UnitedHealthcare sent a formal proposal to Prisma Oct. 28, Prisma asked to terminate both its Upstate and Midland contracts the next day.

The UnitedHealthcare spokesperson said the parties' Midland contract does not expire March 1, 2022, as the previous version of Prisma's website claimed. 

"Prisma is inexplicably spreading inaccurate and misleading information to our members and employers regarding the status of our negotiation," the UnitedHealthcare spokesperson told Becker's. "As Prisma is well aware, we have already agreed to the health system's requested terms for a new multiyear contract that would keep its Upstate hospitals and physicians in our network after Jan 1, 2022. We urge Prisma to move forward with the agreed-upon contract without further delay to prevent unnecessary disruption for its patients and our members."

This story will be updated as more information becomes available.

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