United Healthcare customers in South Carolina will soon have fewer options when they need to make medical decisions.
The health insurance company, which insures 417,000 people across the state, plans to cut all Carolinas Healthcare System providers, including Roper St. Francis doctors and hospitals, from its network Feb. 28.
“We offered to pay Roper St. Francis rates that are similar to what other health plans pay them for the same services, but the hospital system is demanding an increase above the market average without any commitment to the quality or value it provides our customers,” said Daryl Richard, a spokesman for the insurance company. Richard said about 10,000 customers will be affected by this decision.
Roper St. Francis spokesman Andy Lyons said the hospital is committed to quality. “Negotiations continue, but there are significant gaps in what United Healthcare is proposing and what Roper St. Francis considers to be fair rates and contract terms.”
If United Healthcare beneficiaries wish to continue seeing Roper St. Francis providers after Feb. 28, they will be expected to pay higher, out-of-network prices. Emergency care at Roper St. Francis facilities will continue to be covered at in-network rates.
The negotiations do not affect the contracts between United Healthcare and other Charleston-area hospitals. Patients insured by United Healthcare will continue to pay in-network prices at Medical University Hospital, East Cooper Medical Center and Trident Health facilities.
United Healthcare customers who are already receiving care at Roper St. Francis because of an ongoing illness or pregnancy may be eligible for in-network benefits during a transition period, the hospital system’s CEO told patients in a letter earlier this month.
None of this is unprecedented. Health insurance networks are becoming increasingly “narrow” — or “high-value,” as insurance companies like to say — as companies try to control costs by limiting patient choice to hospitals and doctors that provide the best results for the best prices.
This trend is already apparent in the Lowcountry. For example, Consumers’ Choice Health Plan, which offers policies to South Carolinians through the federal health insurance marketplace, does not include Roper St. Francis in its network either. BlueCross BlueShield of South Carolina does not include the Medical University Hospital in its plans offered through the marketplace.
America’s Health Insurance Plans, a national trade organization, commissioned a report last year concluding, “The use of high-value provider networks is one of the tools used by health plans to reduce costs and provide high quality and cost effective care for consumers.” The report found that premiums were 5 percent to 20 percent lower for narrow network plans, compared with “broad network plans.”
All this, of course, is harder to swallow for patients whose choices have been recently restricted.
Colin Smoak, a benefits consultant in Mount Pleasant, called these negotiations between providers and insurance companies “sadly routine.”
“It’s a saber-rattling contest,” Smoak said. “It would surprise me if United Healthcare will stay out at the end of the day.”
Reach Lauren Sausser at 937-5598.