Reno, Nev.-based Saint Mary's Regional Medical Center, which is owned by Ontario, Calif.-based Prime Healthcare, will no longer be in network for Prominence HealthFirst, the provider announced Aug. 18.
The move was effective Aug. 17, with only emergency procedures still covered, according to the announcement. The "difficult" decision was made to preserve "exceptional quality care."
"Unfortunately, Prominence HealthFirst failed its members by refusing to authorize medically necessary care, failing to timely pay for medically necessary services, failing to provide adequate access to post-acute care, and maintaining a consistently low CMS rating compared to other health plans in the community and across the nation," read the Saint Mary's announcement.
Kamal Jemmoua, CEO of Prominence Health Plan, shared the following statement about the contract termination with Becker's:
"Prominence Health Plan puts the healthcare interests of its members first. We always want our members to receive excellent health care as soon as practical since we know that delayed care is counter to our mission and leads to higher medical costs. That is not in the interest of our members, providers nor us as an insurer.
"This action by Prime appears to be less about Prominence and instead seems designed to support the recent launch of their own Medicare Advantage plan and apparent concern over the new 350,000 sq. ft. Northern Nevada Sierra Medical Center opening early next year.
"The fact remains that Prime chose not to work through the contractually agreed to dispute resolution process and unilaterally terminated our agreement with them. Prominence Health Plan is committed to ensuring our members receive the care they need when they need it at the location that makes the best sense for that care."
Saint Mary's Regional Medical Center is still in network with payers like Aetna, Anthem, United and SilverSummit, according to the provider.
Editor's note: This article was updated Aug. 20 at 3:30 p.m. central to include a statement from Prominence.