Prisma Health, UnitedHealthcare in dispute over insurance coverage agreement

State News

SPARTANBURG, S.C. (WSPA) – Prisma Health and UnitedHeathcare are in a dispute over contract agreements. If they can not reach an agreement, Prisma Health will be out of network for UnitedHealthcare users beginning in 2022.

According to an update on Prisma Health’s website, which has since been removed, they offered United Healthcare a number of options that provide access to Prisma Health’s organization at reimbursement rates that reflect the costs of providing medical care, but they were unable to come to an agreement.   

In response to Prisma Health’s release, UnitedHealthcare said, “Prisma is inexplicably spreading inaccurate and misleading information to our members and employers regarding the status of our negotiation. As Prisma is well aware, we have already agreed to the health system’s requested terms for a new multi-year contract that would keep its Upstate hospitals and physicians in our network after Jan 1, 2022. We urge Prisma to move forward with the agreed upon contract without further delay to prevent unnecessary disruption for its patients and our members.”

Contracts will be ending on the following schedule: 

Effective Jan. 1, 2022, Prisma Health hospitals and physicians in the Upstate will be out of network with UnitedHealthcare Medicare Advantage, employer-sponsored health plans, VA Community Care Network, United Behavioral Health and Spectera Eyecare Network plans. 

Effective March 1, 2022, Prisma Health hospitals and physicians in the Midlands will be out of network with the same plans. Exception: Effective April 1, 2022, Prisma Health Tuomey Hospital will be out of network with UnitedHealthcare plans.   

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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