Updated November 7, 2023
An update on our negotiation with Prisma Health
We continue to work hard to move things forward with Prisma and are actively engaged in discussions with the health system. We delivered a new proposal to Prisma on Oct. 18 that included meaningful movement in an effort tobring our negotiation to closure. We continue to await a formal response from Prisma.
The last proposal we received from the health system repeated similar demands that included a 23% price hike over just 15 months for our commercial plan. Agreeing to Prisma’s proposal would increase health care costs by more than $60 million, significantly driving up premiums and out-of-pockets for our members as well as the cost of doing business for both fully insured and self-funded customers. We’ve been clear in our communications to Prisma that these demands are not acceptable, affordableor sustainable for South Carolinians and employers.
It remains our top priority to reach an agreement with Prisma that ensures uninterrupted access to affordable, quality care. We will remain at the negotiating table as long as it takes to reach an agreement. However, we need Prisma to act with a sense of urgency and to either finalize the terms of our latest proposal or deliver a realistic counter South Carolinians and local businesses can afford.
We encourage you to contact Prisma and urge them to renew our relationship at a cost that’s affordable for consumers and employers.
Thank you again for your patience. We value our relationship with you and will continue working hard on your behalf to achieve the goal of providing affordable health care for the people of South Carolina.
Prisma Health is demanding a more than 20% price hike over the next 15 months that would increase health care costs by more than $60 million for employer-sponsored commercial plans.
We have negotiated with Prisma Health for the past several months in an effort to renew our relationship. If we are unable to reach an agreement, the health system’s hospitals, facilities, and physicians will be out of network for employer-sponsored commercial plans and Medicare Advantage plans, effective Jan. 1, 2024.
Our goal is to renew our relationship without any disruption while also helping ensure health care remains affordable for the people and employers we serve throughout South Carolina.
Unfortunately, Prisma Health continues to repeat its demands for a more than 20% price hike over the next 15 months for our employer-sponsored commercial plans, which is not realistic, affordable or sustainable for South Carolinians and employers. Agreeing to Prisma’s proposal would increase health care costs by more than $60 million, significantly driving up premiums and out-of-pocket costs for the people we serve as well as the cost of doing business for employers.
Prisma’s proposal would make the cost of care at its hospitals nearly 25% higher than the market averages in the Greenville and Columbia markets, while the cost of care at Prisma’s physicians would be more than 50% higher than those market averages as well as the state average.
Prisma would be paid significantly more than its peers if we agreed to its proposal. To help illustrate what the impact of Prisma’s proposal would mean for consumers, consider the following example:
- Prisma’s proposal would mean the average cost of an emergency room visit would increase by approximately $750 at one of its Greenville facilities and by more than $560 at one of its Columbia facilities.
More than 15 self-funded businesses in South Carolina would see their health care costs increase by $400,000 or more if we agreed to Prisma Health’s proposal, with five employers seeing their costs increase by at least $1 million.
Approximately $46 million – or nearly 75% – of the more than $60 million increase Prisma is seeking for our employer-sponsored plans would be paid out of the operating budgets of the self-insured businesses we serve.
Prisma’s proposal would impact many businesses’ ability to continue offering affordable health care coverage for their employees. It would also mean they have less money available to pay competitive wages and to help grow the business through things like investments in new technologies.
Establishing competitive contracts with physicians and hospitals is critical to our ability to meet our obligations to the self-funded customers we serve. That is why we are focused on reaching a new agreement with Prisma at rates that are affordable and sustainable for the people and employers we serve.
Prisma is also seeking nearly $20 million in additional rate increases for our Medicare Advantage plan over the entirety of our contract.
Prisma’s proposal would have a direct impact on the benefits we’re able to offer South Carolina seniors who participate in our Medicare Advantage plans and would directly drive up overall health care costs.
We continue to compromise and have delivered multiple proposals to Prisma that include meaningful rate increases that help ensure the health system continues to be fairly and appropriately reimbursed for the care it provides.
Prisma orchestrated a communications campaign more than four months before our contract expires and put South Carolinians in the middle of our negotiation presumably as part of an effort to use public pressure to obtain the significant price hikes the health system is seeking.
Our goal was to negotiate in good faith behind closed doors over the ensuing months in an effort to find a resolution. Unfortunately, Prisma distributed communications to thousands of our members and employer group customers, creating unnecessary anxiety and stress on South Carolina families.
Upon responding to inquiries caused by Prisma’s early communications, Prisma then attempted to silence us by filing a preliminary injunction in an effort to prevent us from speaking about the negotiation as well as the rate increases the health system was seeking. The court has since ruled in UnitedHealthcare’s favor and dismissed Prisma’s motion for an injunction.
Prisma’s actions seemingly indicate they wanted to limit information from the general public regarding the more than 20% price hike the health system is seeking over the next 15 months for our employer-sponsored commercial plans.
This is just another example in a growing list of tactics by Prisma in recent years as they attempt to control the narrative by excluding certain key facts from the public. Just two years ago Prisma issued misleading an inaccurate information regarding our negotiation when we had an agreement in principle on a new contract. Prisma later walked back its public statements.
In the event Prisma leaves our network, people enrolled in our Group Retiree PPO plan may still receive care from a Prisma physician or facility as an out-of-network provider, if they are a Medicare-approved provider that accepts the plan. Their share of the cost will be the same as if they were part of the network.
UnitedHealthcare Group Retiree members are encouraged to speak with their physician to confirm they’ll continue to see them, regardless of their network status.
For additional information about our Group Retiree plan as well as information on how to find a provider in their area, UnitedHealthcare members should go to www.retiree.uhc.com.
Our goal is to reach an agreement without any disruption to the families we serve. We continue to urge Prisma Health to join us at the negotiating table with a reasonable proposal that’s affordable and sustainable for the residents and businesses we serve throughout South Carolina.
We know the relationship our members have with their doctor is not only important; it’s personal. That is why our top priority is to renew our relationship with Prisma Health so the people we serve have continued access to the facilities and physicians they know and trust for their health care needs. We are committed to meeting with the health system as often as it takes to reach a new agreement.
However, should Prisma choose to leave our network, we have created the following page dedicated to information about continuity of care as well as alternative physicians and hospitals remaining in our network.