GREENVILLE, S.C. (WSPA) – It’s been more than six months since negotiations began between UnitedHealthcare and Prisma Health.
The fees Prisma Health will charge patients and the fees UnitedHealthcare will pay Prisma have yet to be agreed upon.
The battle between Prisma Health and UnitedHealthcare continues, and patients say it’s hurting.
Prisma Health, the region’s largest health system, and UnitedHealthcare, the nation’s largest insurer, are battling over fees, with roughly 60,000 patients feeling the effects.
This is a back-and-forth issue with each side blaming the other.
“Over the past year, we have signed renewal agreements with all other health insurance companies and have remained in their networks because the terms were fair and reasonable,” Prisma Health said in a statement.
“Our latest proposal ensures that Prisma will be reimbursed at rates that are more than fair and reasonable,” UnitedHealthcare said in a statement.
Patients said they suffered no matter which company was to blame.
“I had to have surgery on my foot,” said affected patient Anita McLeod, “I knew going to a Prisma doctor would cost over $100 for the consultation and the cost of the surgery would be prohibitive. I was forced to shop around and ended up having the surgery in Spartanburg.”
As of Jan. 1, United Healthcare is no longer in Prisma Health’s network.
“Out-of-network visits are usually much more expensive,” says David Brancati, M.D., an unaffiliated emergency medicine physician. “In fact, many insurance plans may not cover most of it.”
If patients want to continue seeing Prisma Health doctors, they can apply for “continuing care,” but will have to pay a copay.
“They sent me a bill that I had to pay before the appointment, which was basically called a copay bill, and they gave me a 35 to 50 percent discount off of that,” Jean MacLeod said. “But I still had to pay $125 to $130 just to see this doctor.”
Jean MacLeod said she used to pay $12 to $15.
He and his wife, Anita, couldn’t risk being seen by a doctor who didn’t know them well.
Anita said she has battled cancer three times in the past 20 years.
“I had another scare and my surgeon said he won’t be taking me off for six to eight months,” Anita McLeod said. “I have to be seen every other month.”
Dr. David Brancati, who is not affiliated with either system, said solving the problem won’t be easy.
“Hospital systems are expanding and their jurisdictions are expanding,” Dr. Brancati says, “so that gives them leverage with insurance companies, and insurance companies want to expand their networks, get more patients, and have more leverage with hospitals. If they say, ‘You’ve got more members,’ and say, ‘You’ve got to take us on,’ they’re going to miss out on a lot of business.”
“Over the past year, we have entered into renewal agreements with all other health insurance companies and have remained in their networks because the terms were fair and reasonable,” Prisma Health told 7News.
“Our latest proposal ensures that Prisma will be reimbursed at a rate that is more than fair and reasonable,” UnitedHealthcare said in a statement.
As Dr. Brancati noted, this is a tug of war between Prisma Health and UnitedHealthcare, and at this point, it’s unclear when the two companies will reach an agreement.
The McLeods are offering advice to patients who have been affected in a similar way to them: If they want to continue seeing a Prisma Health doctor, they say they can call Prisma’s patient assistance department for additional help.
