Officials with Dayton’s largest health system and insurance giant UnitedHealthcare say they remain open to talking, despite contract negotiations breaking down.
If the two sides fail to reach an agreement soon, an estimated 60,000 Premier Health patients may need to find new doctors.
The deadline for reaching a deal is May 14. After that, many people with employer-based and Medicaid plans will have to pay out-of-network for Premier hospitals and physicians.
"You could use the hospital in an emergency situation, everyone is protected, but not for elected procedures," says Scott McGohan, CEO of insurance brokerage firm McGohan Brabender. "In that case consumers will pay out-of-network costs."
There may also be other options available for newly out-of-network patients with established Premier primary care physicians.
Mary Boosalis, president and CEO of Premier Health, says officials are offering qualifying, non-Medicare UnitedHealthcare patients to pay a flat fee of $25 per primary care office visit, $30 for an e-visit, and $45 for a so-called virtual visit.
The primary care flat fee would be available for visits such as physicals, chronic-disease management and other routine or minor care. Premier officials say the offer will be available until the health system is back in network with UnitedHealthcare, or through December 31, 2017.
Boosalis says specialty care or procedures would remain out-of-network.
Premier and UnitedHealthcare agreed last week to preserve Medicare coverage until the end of 2017.
McGohan's company represents about 1,200 employee health benefit-providing employers in Ohio. He says the Dayton health-care market is less competitive than in Columbus and Cincinnati, with fewer hospital systems. As a result, he says, health-care costs are typically higher.
McGohan says he's hopeful Premier and UnitedHealthcare will reach a deal to preserve patient plans in the Dayton area.
"We need lower health care costs. We also need competitors in our marketplace. We can't afford to lose a lot of nurses and doctors, we can't afford to lose a competitor. It is mission critical that they reach an agreement."
Premier Health officials released a statement:
"At its heart, Premier Health’s disagreement with UnitedHealthcare is about patient choice. We believe that patients should have a transparent choice of quality health care providers, based on their experiences as well as quality and cost data. We do not believe that UnitedHealthcare should effectively make that choice for patients. To minimize any disruption to patient care, Premier Health offered to extend our contract with UnitedHealthcare through the end of the year (without a rate increase). UnitedHealthcare rejected our offer. Despite this response, Premier Health continues to keep the lines of communication open with UnitedHealthcare so that we can resolve this matter as soon as possible on behalf of our patients."
Minnesota-based UnitedHealth Group is the nation’s largest insurance provider, with revenues in 2016 of $148.6 billion.
In a statement, officials said the insurer is committed to continuing discussions with Premier, and working on an "acceptable" solution.
“As one of the most expensive health systems in Southwestern Ohio, Premier continues to make demands that would prevent employers from giving their workers incentives for choosing quality, cost efficient care providers and instead, insists on continuing to drive up costs for the community.”
People who may be affected by policy changes are urged to contact UnitedHealthcare for more information on options for health care.