Dayton, Ohio-based Premier Health and Minnetonka, Minn.-based UnitedHealthcare reached a contract impasse that could affect 70,000 policyholders, Dayton Daily News reports.
An in-network contract between Premier and UnitedHealthcare is set to expire April 29 for employer-sponsored health plans and Medicare beneficiaries, and May 13 for Medicaid coverage. So far, the parties have not been able to resolve a dispute over an aspect of UnitedHealthcare's plan design.
Under UnitedHealthcare's design, hospitals and providers are ranked in tiers. What tier a hospital or provider is ranked at depends on cost and quality metrics, according to Dayton Daily News.
Caitlin Clipp, UnitedHealthcare's executive director in southwest Ohio, said, "Premier Health Network wants its hospitals to be considered Tier 1, but won't commit to meeting the cost efficiency requirements to be Tier 1. Listing Premier Health's facilities as Tier 1 when they do not meet the cost efficiency requirements would be inappropriate and unfair for our employers and members."
However, Premier said it "is reimbursed for approximately 500 kinds of diagnosis-related groups. For some kinds of procedures, we receive more reimbursement than other health systems and hospitals do; for other procedures, we are reimbursed considerably less." Premier said for UnitedHealthcare to call attention to any one particular service "is a gross distortion of the facts."
UnitedHealthcare has notified patients of the potential network change, though negotiations are ongoing. Premier officials said they "anticipate resolving the negotiations with UnitedHealthcare by the contract deadline of April 29."
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