Prisma Health and UnitedHealthcare (United) have reached a new multi-year agreement.
Officials said the new agreement ensures that Prisma Health hospitals, physician practices and other health care services are in-network for all United Commercial and Medicare Advantage health insurance plans.
“I am pleased that United agreed to equitable reimbursement that reflects the increased costs we incur for the provision of medical care to our patients,” said Mark O’Halla, president and CEO of Prisma Health.
O'Halla added, “These terms will allow us to prioritize patients' needs and provide our physicians and hospitals with the resources required to deliver high-quality health care to United health plan members.”
Prisma Health officials said they are communicating with affected patients to ensure they are aware of the new agreement, which is retroactive to June 1, 2024.
When Prisma Health and UnitedHealthcare failed to reach a contract in January, thousands of patients had to switch health providers or pay out-of-network rates for their care.
UnitedHealthcare, in a statement, said Prisma had demanded “outlandish price hikes” of nearly 20 percent over a year that would “increase health care costs by approximately $50 million for just our employer-sponsored commercial plans.”
In its statement, Prisma said it had sought a 10-percent increase over two years and that UHC failed to submit a “reasonable proposal … that reimburses us for the cost increases we have and continue to absorb for their health plan members.”
It added that it had reached agreements with all other major insurers in the past year.
The new agreement’s terms weren’t disclosed.
Prisma Health is a private nonprofit health company and the largest health care organization in South Carolina. The company has 29,309 team members, 18 acute and specialty hospitals, 2,827 licensed beds, 305 practice sites, and more than 5,400 employed and independent clinicians across its clinically integrated inVio Health Network.
Along with this network, Prisma Health serves almost 1.5 million unique patients annually in its 21-county market area that covers 50 percent of South Carolina.