SUMMER, S.C. — Ongoing negotiations between a South Carolina hospital system and a major insurance company are causing headaches and fear for some people in the Midlands.
The past month has been full of stress and phone calls for Helena Sattele. She lives in Sumter and receives medical care through her Medicare Advantage Plan. united healthcare. She said she received a letter from the hospital in November. Prisma Toomey HospitalOn January 1, her insurance plan will no longer be accepted at that location.
“I was worried about that. When this plan was first announced, I had a lot of friends, at least 15 of them, and their husbands enrolled in the plan. It's a great plan,” she said. Masu.
according to united healthcare, officials are in the midst of months of negotiations with Prisma Hospital System. Because no agreement has been reached yet, Medicare Advantage plans like Helena's will not be available when the new year begins.
“On December 5, we submitted a new proposal to Prisma that included significant compromises,” the agency said in part in a statement. Prisma responded nine days later with a proposal that actually widened the gap between our organizations in negotiations. Prisma continues to call for more than 20% increases in commercial plans that go into effect over the next 12 months, which are neither affordable nor sustainable for South Carolinians or employers. Prisma's actions indicate that it intends to leave the network, given its repeated and outlandish requests for price increases throughout our negotiations. If Prisma offers a realistic proposal, we are willing to continue the discussion. ”
Sattel said she was worried because Tuomey Hospital is the closest hospital for her and her family, and other facilities other than Prisma are too far away.
“I have to go to Colombia, which is actually closer than Florence. I timed it and it took me 35 minutes to get to Colombia and closer to 50 minutes to get to Florence,” she said.
with chris johnson Laurie's life and health, an independent insurance agency, says there are solutions if you find yourself in this situation. Friday is the last day for public enrollment in health care providers, but Medicare Advantage customers also have more time to make changes.
“There's another period that starts in January. It's called the Medicare Advantage Open Enrollment Period. That means people who have a Medicare Advantage plan have a You have one opportunity to change to a different plan,” he says.
United Healthcare also supports News members who are being treated by a Prisma Health provider or who have a serious acute or chronic illness that may qualify for continued care (in the second or third trimester). Tell news members that this includes women of all ages. Up to 6 weeks after birth. Also, patients who have been newly diagnosed with cancer, have relapsed cancer, or are currently undergoing cancer treatment.
Sattel said she remains hopeful that a solution can be found for her health. “We hope that by the end of the year we will be able to resolve the situation and be able to maintain the policies that we currently have in place. It will be easier for everyone,” she said.
We reached out to prisma health I asked for comment and was told they would not comment.
