What UnitedHealthcare patients can expect after no agreement with Prisma Health
(WIS) - UnitedHealthcare (UHC) said patients in the middle of treatment with a Prisma Health provider or those who have a serious condition may be eligible for continuity of care, which would allow them to continue receiving covered services for a specified period of time.
Prisma Health and UHC failed to reach an agreement to renew their contract in 2024, meaning more than 50,000 patients will be forced to pay more out-of-pocket for medical care.
Examples of patients who may qualify include women who are pregnant, patients with newly diagnosed or relapsed cancer, and those currently in active cancer treatment.
“I know that there’s also a lot of elderly people who are losing all of this as well,” Lexington resident Chrystal Shipley said, “They’re in a far worse situation than I’m in.”
UHC also said members should go to the nearest hospital in the event of an emergency. They said their care will be covered at the in-network benefit level, regardless of whether the hospital participates in the UHC network.
A portion of the UHC statement provided to WIS about negotiations with Prisma reads:
“Prisma Health did not counter our Dec. 27 proposal and allowed our contract to expire. Throughout our negotiation Prisma maintained its demands for unsustainable price hikes that would have made its hospitals and physicians significantly higher cost than the Columbia and Greenville 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.”
According to United, roughly 58,000 members received services from a Prisma provider over the last 12 months.
In Prisma’s release sent to us on Tuesday, the hospital system noted in their last communication with UHC on December 30th, they “asked United to submit a reasonable proposal. UHC refused to do so, which resulted in them placing Prisma Health as out-of-network.”
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