COLUMBIA — Concerns for United Healthcare Insurance Holders

People with United Healthcare insurance may soon find themselves without coverage at SSM Health Providers.

On November 24, SSM Health issued a statement indicating that they are trying to negotiate an agreement with United Healthcare.

If a deal isn’t reached by January 1, SSM Health’s facilities and physicians in Missouri and Illinois will no longer be part of United Healthcare’s network, which includes employer-sponsored plans like UMR and Shrest, as well as a Medicaid plan.

However, those enrolled in certain Medicare Advantage plans, including Dual Special Needs Plans and Medicare Supplement plans, will still have in-network access to SSM Health after January 1, United Healthcare confirmed. These specific plans are unaffected by the ongoing negotiations.

“Failure to finalize an agreement by December 31 could lead to increased costs and fewer healthcare options for many Missouri families,” Adam Moss, director of marketing and communications for SSM Health, mentioned in an email to KOMU 8 News on Wednesday. “We are committed to ensuring that our communities can continue to access the essential care they deserve. That’s all the information we have for now.”

In a response, United Healthcare stated they are in active talks with SSM Health to renew their network relationship.

“Our objective is to reach a deal that remains affordable for consumers, employers, and Missouri taxpayers while ensuring consistent access to healthcare,” United Healthcare said in their email statement.

According to United Healthcare, SSM Health is asking for a 14% increase over two years for its commercial plans. Meanwhile, they are proposing competitive rate increases that aim to keep reimbursement rates fair.

SSM has a vast presence, with over 1,000 locations across the country. The most notable in Missouri is SSM Health St. Mary’s Hospital located in Jefferson City, along with other sites in rural areas like Bell, Tipton, and Warrenton.

United Healthcare provides insurance for large employers in Boone and Cole counties, which include the University of Missouri, MU Healthcare, Columbia Public Schools, Quaker Windows and Doors, and the Jefferson City School District. The largest employer in Cole County is the State of Missouri, which offers health insurance through the Missouri Integrated Health Plan.

In a November 24 release, SSM Health criticized United Healthcare’s for-profit approach.

“While United Healthcare reported substantial profits last year, SSM Health, as a nonprofit Catholic health organization, continues to serve all patients, especially those who are vulnerable and unable to afford care,” they stated. “The profits they generate come at the expense of timely treatment and from mission-focused hospitals struggling to keep up with rising costs and complex patient needs, which United Healthcare does not adequately reimburse.”

A spokesperson for United Healthcare responded, claiming SSM Health is trying to divert attention from the negotiations.

“SSM Health is issuing a termination notice and making misleading statements about our negotiations, as we aim for an agreement that is fair for our insured and employers,” the spokesperson asserted. “They are seeking a 14% increase over two years for commercial plans, and these cost raises will largely affect local employer budgets, which are crucial for business growth and staff compensation. SSM Health’s fees are significantly higher than the average costs in Missouri’s Medicaid network, creating an unsustainable burden on taxpayers. Our priority is to negotiate fairly, but we also need SSM Health to present a reasonable proposition for families and businesses.”

United Healthcare claims that SSM Health charges significantly more than other providers in Missouri’s Medicaid network, at times up to 40% higher based on provider type and location.

In a recent news release, SSM Health encouraged patients to reach out to United Healthcare and included a contact number for NEO Insurance Solutions. However, NEO Insurance Solutions seems to have no public connections apart from its chief commercial officer, Kyle Dietz, who previously worked with United Healthcare.