COLUMBIA — Individuals with United Healthcare insurance are at risk of losing coverage at SSM Health providers.

SSM Health released a statement on Nov. 24 stating that SSM Health was attempting to come to an agreement with United Healthcare.

If the organizations do not reach an agreement, effective Jan. 1, SSM Health’s hospitals, facilities and its physicians in Missouri and Illinois will be out of network for employer-sponsored commercial plans, including UMR and Surest, and its Medicaid plan, the United Healthcare Community Plan.

People enrolled in Medicare Advantage plans, including Dual Special Needs Plan, Group Retiree, as well as Medicare Supplement plans, will continue to have network access to SSM Health on and after Jan. 1, according to United Healthcare. These plans are not affected by United Healthcare’s current negotiation with SSM Health.

“If an agreement isn’t reached by Dec. 31, thousands of Missouri families could face higher costs and fewer care options,” Adam Moss, the marketing and communications director for SSM Health, told KOMU 8 News in an emailed statement Wednesday. “Our priority remains ensuring uninterrupted access to the high-quality care our community trusts. This is all the information we have at this time.”

United Healthcare told KOMU 8 News in a statement Wednesday afternoon that it is actively negotiating with SSM Health to renew their network relationship.

“Our goal is to reach an agreement that is affordable for consumers, employers and Missouri taxpayers while maintaining continued, uninterrupted network access to the health system,” United Healthcare wrote in the emailed statement.

United Healthcare said SSM Health is seeking a 14% price hike over two years for the organizations’ commercial plans. United Healthcare said it is proposing rate increases for its commercial plans that would reimburse SSM Health at market-competitive rates.

SSM has over 1,000 locations nationwide with its most prominent Missouri location being SSM Health St. Mary’s Hospital in Jefferson City. It also has rural locations in Belle, Tipton, Warrenton and more.


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United Healthcare provides insurance to some of the largest employers in Boone County and Cole County, including the University of Missouri, MU Health Care, Columbia Public Schools, Quaker Windows and Doors, and the Jefferson City School District, according to the organizations’ websites. The state of Missouri is the largest employer in Cole County and uses the Missouri Consolidated Health Care Plan, a standalone state entity that provides health coverage.

SSM Health is a nonprofit organization and criticized United Healthcare’s for-profit model in its Nov. 24 release.

“United Healthcare reported billions in profits last year, while SSM Health, as a nonprofit Catholic health system, continues to care for all patients, including those most vulnerable and unable to pay,” SSM Health said in the statement. “UHC’s massive profits are derived from delaying and denying care to patients and their unwillingness to recognize mission-based hospitals rising costs and increasingly complex patient needs, UHC has declined to offer reimbursement rates that sustain access to care.”

A United Healthcare spokesperson issued a rebuttal in the emailed statement to KOMU 8 News.

“SSM Health issued a notice to end our contract and is making false allegations to distract from what our negotiation is really about, which is reaching an agreement that is affordable for the people and employers we serve,” the United Healthcare spokesperson said in the statement. “SSM Health is seeking a 14% price hike over two years for our commercial plans. The majority of these cost increases would come out of the budgets of local employers, impacting the money they have to grow their business and compensate their employees. SSM Health is also significantly more expensive than the average cost of all other providers in our Medicaid network in Missouri, driving up costs for taxpayers at an unsustainable rate. Our top priority is to reach an agreement that maintains continued network access to SSM Health. However, we need the health system to provide a proposal that’s affordable for Missouri and Illinois families as well as local companies.”

United Healthcare said SSM Health is significantly more expensive than the average cost of all other providers in its Medicaid network in Missouri. United Healthcare said SSM Health is reimbursed as much as 40% more than some providers in its Medicaid network in the state, depending on the provider type and location.

In its news release, SSM Health encouraged patients to contact United Healthcare but attached the number to NEO Insurance Solutions, which has no public connection outside of Chief Commercial Officer Kyle Dietz, who formerly worked for United Healthcare.

Update

This story was updated with information and quotes from a statement from United Healthcare, as well as information about employers that use United Healthcare.