Nearly 58,000 people remain caught in the middle of a stalemate between Prisma Health and UnitedHealthcare, including some Medicare patients. Now, we’re learning about a new challenge that affects those most in need of care and those on fixed incomes. Retirees Jane and Anita McLeod have lived in Greenville for decades. Gene says they literally trust the cancer doctors at Anita Prisma with their lives. “She has survived three attacks and two bouts of chemotherapy and radiation and is still going,” he said. UnitedHealthcare oversees medical care at McLeods. So, instead of Prisma filing an out-of-network claim, the McLeods would need to pay out of pocket up front for the appointments. If they want any compensation, they will have to apply to UnitedHealthcare themselves. “If someone has multiple appointments during the month, they could be faced with a bill of $200, $300, or $400. And then they have to wait for their money,” Jain said. According to UnitedHealthcare, they can wait up to $60 to $90. days. The McLeods are two of many fixed-income retirees who rely on Medicare. “You have people who don’t have a lot of income and they’re probably going to have to either shell out money they may or may not have or skip an appointment,” Jain said. We reached out to UnitedHealthcare about this, and they responded: “It is disappointing to learn that Prisma is declining to file out-of-network claims on behalf of our members, forcing some of South Carolina’s most vulnerable patients to pay upfront for non-emergency services. It is standard practice Out-of-network providers, like Prisma, file out-of-network claims on behalf of their patients. We believe this is just another tactic by Prisma intended to unnecessarily put South Carolinians in the middle of our negotiations. We will process out-of-network claims in accordance with the member’s benefits plan and reimburse Prisma for the care provided. UnitedHealthcare members experiencing this issue with Prisma should contact us at the number on their health plan ID card, and we will help them find an in-network provider who will provide the care they deserve. We have reached out to Prisma Health about this matter. They responded : “Effective January 1, UnitedHealthcare (UHC) placed Prisma Health out of network for its health plan members, including Medicare Advantage. We remain at the negotiating table and ask UnitedHealthcare to present a reasonable proposal that would quickly reinstall Prisma Health as an in-network option. That’s why we’re reaching out to every patient with UHC insurance who has an appointment at Prisma Health in 2024 to discuss their options, which include: switching to a health insurance plan that includes Prisma Healthseeking services from in-network providers applying for continuity of care benefits. Through UHC (if eligible) provide an advance payment that reflects a self-pay discount, or cancel their appointment. “Unfortunately, UHC’s refusal to contract with Prisma Health on reasonable terms leaves their health plan members with only these options.” To reach agreements with all other major insurers negotiated over the past year that recognize the increased costs incurred by Prisma Health – all except UHC. This is just more proof that Prisma Health is affordable, but universal health coverage is not. “To change oncologists,” he said. “And she wouldn’t change her other doctors. I feel the same way. “We can make some adjustments to our lifestyles, but if she gets sick and has to be hospitalized and they want money up front, it will be a severe hardship for us. “Supplemental UHC plans are still accepted among those plans.
Nearly 58,000 people remain caught in the middle of a stalemate between Prisma Health and UnitedHealthcare, including some Medicare patients. Now, we’re learning about a new challenge that affects those most in need of care and those on fixed incomes.
Retirees Jane and Anita McLeod have lived in Greenville for decades. Gene says they literally trust the cancer doctors at Anita Prisma with their lives.
“She has survived three attacks and two bouts of chemotherapy and radiation and is still going,” he said.
UnitedHealthcare oversees McLeods’ medical care. So, instead of Prisma filing an out-of-network claim, the McLeods would need to pay out of pocket up front for the appointments. If they want any compensation, they will have to apply to UnitedHealthcare themselves.
“And if someone has multiple appointments during the month, they could face a bill of $200, $300, $400. And then they have to wait for their money,” Jain said.
According to UnitedHealthcare, they can wait 60 to 90 days. The McLeods are two of many fixed-income retirees who rely on Medicare.
“There are people who don’t have a lot of income and are likely to have to either cash out money they may or may not have or skip an appointment,” Jain said.
We reached out to UnitedHealthcare about this matter, and they responded:
“It is disappointing to learn that Prisma is declining to file out-of-network claims on behalf of our members, forcing some of South Carolina’s most vulnerable patients to pay upfront for non-emergency services. It is standard practice for out-of-network providers, like Prisma , filing out-of-network claims on behalf of their patients. We believe this is just another tactic by Prisma intended to unnecessarily put South Carolinians in the middle of our negotiations. We will process out-of-network claims in accordance with the member’s benefits plan and reimburse Prisma for the care provided. Members should UnitedHealthcare who are experiencing this issue with Prisma call us at the number on their health plan ID card, and we will help them find an in-network provider that will provide the care they deserve.
We have reached out to Prisma Health about this matter. They answered:
“Effective January 1, UnitedHealthcare (UHC) has designated Prisma Health as out-of-network for its health plan members, Including Medicare Advantage. We remain at the negotiating table and ask UnitedHealthcare to present a reasonable proposal that would quickly reinstall Prisma Health as an in-network option.
“As an out-of-network provider, Prisma Health does not have the ability to file claims or collect copayments for patients with UHC insurance. For this reason, we are reaching out to every patient with UHC insurance who has an appointment at Prisma Health in 2024 to discuss their options, which include:
- Switch to a health insurance plan that includes Prisma Health
- Request services from service providers within the network
- Apply for continuity of care benefits through UHC (if eligible)
- Provide an advance payment that reflects the self-pay discount, or
- Cancel their appointment.
“Unfortunately, UHC’s refusal to contract with Prisma Health on reasonable terms leaves their health plan members with only these options.
“Prisma Health has been able to reach agreements with all of the other major insurers it negotiated with over the past year, which recognize the increased costs incurred by Prisma Health – all except UHC. This is just further proof that Prisma Health is affordable, but universal health coverage it’s not.”
Gene says Anita will keep going to her appointments. She is still recovering from her ovarian cancer diagnosis two and a half years ago.
“Anita will not change oncologists,” he said. “She won’t change her other doctors. I feel the same way. We can make some adjustments in our lifestyles, but if she gets sick and has to be hospitalized, and they want money up front, it will be too much for us.”
Supplemental UHC plans are still acceptable. Medicare Advantage is not one of those plans.