Prisma Health and United Healthcare: Can They Fix This In Time?

Attention South Carolina UnitedHealthcare Members: Important Update on Prisma Health Network Status

Hey there, South Carolina UnitedHealthcare members! Important news about Prisma Health, a major healthcare provider in the state, going out-of-network for all UnitedHealthcare members, including those with Medicare Advantage plans, starting January 1st, 2024.

This means increased out-of-pocket costs and administrative burdens for UnitedHealthcare members receiving care at Prisma Health facilities.

Why this change? Negotiations between Prisma Health and UnitedHealthcare have stalled. Prisma Health claims UnitedHealthcare refuses to agree to fair terms reflecting healthcare cost increases. Other South Carolina insurers have successfully reached agreements with Prisma Health, demonstrating compromise potential.

What are your options?

Medicare Advantage Members:

  • Consider the Medicare Advantage Open Enrollment Period (OEP): This is your chance to review your current plan and explore other options. The OEP runs from January 1st to March 31st, 2024. During this period, you can switch to a plan that includes Prisma Health in-network, starting April 1st, 2024.
  • Contact your Medicare plan: Discuss out-of-pocket costs for Prisma Health services and any “out-of-network” or “continuity of care” benefits available.
  • Explore other Medicare Advantage plans: Many plans are available from different insurance companies. Call us at 803-848-0089 to compare plans and find one that suits your needs and includes Prisma Health in-network.

All UnitedHealthcare Members:

  • Contact your employer: They might answer questions about your specific benefits and offer alternative in-network providers.
  • Explore Marketplace plan options: If you have a UnitedHealthcare Marketplace plan, you can switch carriers by December 15th, 2023, to stay in-network with Prisma Health. We can help! Call us at 803-848-0089 for assistance.
  • Visit the Prisma Health website: They offer FAQs and resources at Prisma.Health/UnitedHealth.
  • Call Prisma Health directly: Their patient contact center at 864-455-9981 can answer questions about Prisma Health services.

Remember: Negotiations are ongoing, but there’s no guarantee an agreement will be reached before January 1st. Be prepared for potential out-of-network costs and explore alternative healthcare options if needed.

Don’t miss the deadlines:

  • Medicare Advantage Members: The OEP to switch plans ends March 31st, 2024.
  • Marketplace plan members: The deadline to switch carriers is December 15th, 2023.

We’ll keep you updated: We’ll share any new information as soon as we have it. In the meantime, don’t hesitate to contact your employer, UnitedHealthcare, your Medicare plan, or us at 803-848-0089 for guidance.

You can also email us HERE or message us HERE.

We hope this information helps!

Below is the letter that Prisma sent to it’s members:

On Dec. 5 Prisma Health sent the following messages to patients with United Healthcare insurance:

“Prisma Health deeply appreciates the opportunity to be a part of your health care team. According to our records, you receive your health insurance coverage through a UnitedHealthcare plan. Therefore, we are writing to share an important update regarding your in-network access to the Prisma Health physicians, nurses, and providers you know and trust.

“For nearly a year, Prisma Health has been negotiating with UnitedHealthcare in good faith regarding new contracts that cover the care we provide to their members. Although those discussions are continuing, there has been no meaningful progress. While Prisma Health and other major health insurance companies in South Carolina have partnered and come to an agreement on fair contract terms that recognize the extraordinary inflationary cost increases Prisma Health is bearing for their health plan members, UnitedHealthcare has refused to do so.

“Therefore, as it stands today, Prisma Health hospitals and providers will be out of network with all UnitedHealthcare insurance plans on Jan. 1, 2024.

“Here is information you will need if no agreement is reached by Jan. 1:

  • Individuals covered under a UnitedHealthcare insurance plan will likely see an increase in their out-of-pocket costs if they choose to receive medical services from a Prisma Health physician or facility in 2024.
  • Being out of network with Prisma Health will also create work for you. Out-of-network members may have to obtain prior authorization and make advance payments for physician visits, tests, procedures, surgeries and hospitalizations at Prisma Health.

“How you can prepare:

  • Contact your employee benefits or human resources department if your UnitedHealthcare health insurance is through your employer. They may be able to help you understand your options if you wish for Prisma Health to remain an in-network provider for you.
  • Contact UnitedHealthcare at the number on the back of your insurance card to get information about benefits and any out-of-pocket costs that may change.  Some questions a patient may ask UnitedHealthcare include:
    • Do I have an “out-of-network” benefit?
    • Do I have Continuity of Care benefits?
    • Can you work with Prisma Health and its physicians and other providers to protect access to the care I need and deserve?
  • Visit Prisma.Health/UnitedHealth for FAQs and other resources that may be helpful to you.
  • We are here for you – Prisma Health’s patient contact center can be reached at 864-455-9981, Monday–Friday, 8 a.m.–5 p.m. for other questions you may have.

“In the event we do reach an agreement with UnitedHealthcare, we will let you know as soon as possible. Thank you for trusting Prisma Health with your care needs.”