Updated March 22, 2024
An update regarding our negotiation with Prisma Health
Thank you for your support as we continue our efforts to renew our relationship with Prisma Health.
We remain engaged in discussions with Prisma and are actively exchanging proposals. We delivered our ninth proposal to Prisma on March 21 that included additional rate increases on top of what we’ve previously proposed. Our latest offer would ensure Prisma is reimbursed at rates that are more than fair and reasonable. We hope Prisma finalizes the terms of our proposal or provides a counter that is acceptable and affordable for South Carolinians and the employers we collectively serve.
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 refused to move off its demands for unsustainable price hikes and is now out of network
Despite our many efforts to compromise, Prisma Health has chosen to leave our commercial and Medicare Advantage network as of Jan. 1. We delivered a proposal to Prisma on Dec. 27 that included meaningful rate increases that were well above the year-over-year Consumer Price Index trends for hospital and physician services. Prisma did not counter our proposal and allowed our contract to expire.
Our goal was to reach an agreement that ensured continued, uninterrupted access to Prisma at an affordable cost for South Carolinians and employers. Unfortunately, Prisma made that outcome unrealistic due to its refusal to move off its demand for a nearly 20% price hike that would take effect in the first 12 months of our commercial contract and would increase health care costs by nearly $50 million. Prisma’s proposal would have made its hospitals and physicians significantly higher than the market averages in Columbia and Greenville.
Prisma also sought significant rate increases for our Medicare Advantage plans that would have increased health care costs by more than $16 million.
While we remain committed to continued good-faith negotiation, our focus now is ensuring the people and families we serve have access to the care they need through either continuity of care or a seamless transition to a new provider.
Prisma’s proposal would make the cost of care at its hospitals and its physicians significantly higher than the market averages in Greenville and Columbia.
Approximately 75% of the nearly $50 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 more than $16 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 compromised and 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 unsustainable price hikes the health system has sought throughout our negotiation.
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.
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 retiree.uhc.com.
Our goal is to reach an agreement that restores network access to Prisma. We continue to urge Prisma 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 reach an agreement with Prisma Health and to restore network access to the health system. We are committed to meeting with the health system as often as it takes to reach a new agreement.
We have created the following page dedicated to information about continuity of care as well as alternative physicians and hospitals remaining in our network.