United Healthcare customers in Missouri could lose their out-of-network insurance coverage at SSM Health at the end of this month if both sides fail to make a deal.
The state Department of Commerce and Insurance told Missourinet the deadlock impacts about 27,000 Medicaid patients and 24,000 commercial members. Director Angela Nelson said she’s still optimistic that both sides can come together.
She explains how the deadlock would affect patients if both sides fail to reach a deal in time.
“So generally speaking, there will be higher deductibles, co-payments, co-insurance provisions, if you choose to go out of network. For most plans today, there are still benefits under the plan if you go out of network. It’s just that your cost-sharing, what you will pay out of pocket, may increase,” said Nelson.
Which patients would not be affected?
“It does not impact Medicare. It does not impact Medicare Advantage, including seniors that are on something called a Dual Needs, a special plan. It will not impact those,” she said.
Health systems and insurance companies routinely negotiate how much insurers reimburse hospitals for screenings, checkups, surgeries, and many other services.
“My understanding is SSM has asked for a 14% hike in their rates over two years,” said Nelson. “That would mean an increase for United (Healthcare) of about $41 million a year.”
Nelson said healthcare costs are rising at a much faster pace than inflation.
“Providers are in a very difficult situation with rising costs,” said Nelson. “And then we’ve got this situation where we’ve got employers who are struggling with all of their rising costs as well. But at the same point in time, health insurance companies are struggling to keep premiums low.”
She has advice for patients:
“Be talking to your friends, your family, your co-workers, getting good recommendations for other physicians that they might be able to utilize,” said Nelson. “It’s probably also a good opportunity if folks are getting low on medication to reach out to your providers and see if you can get a refill.”
The higher rates could then be passed on to Missouri businesses and their employees.
Nelson also encourages patients to reach out to the department if they have any questions: dci.mo.gov or call 573-751-4126.
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