SUMTER, S.C. — An ongoing negotiation between a South Carolina hospital system and a large insurance company is creating headaches and fear for some in South Carolina.
The past month has been full of stress and phone calls for Helena Sattele. She's a Sumter resident who received healthcare via a Medicare Advantage plan with United Healthcare. She said that in November, she received a letter from her hospital, Prisma Tuomey Hospital, that on Jan. 1, her insurance plan would no longer be accepted at that location.
"It concerned me. I had signed up a lot of friends, at least fifteen people, and their husbands for this plan when it originally came out; it's a great plan," she said.
According to United Healthcare, it is in the middle of months-long negotiations with Prisma Health. Since an agreement hasn't been made yet, Medicare Advantage plans, like Helena's, won't be available once the new year starts.
The agency said in a statement,
"We delivered a new proposal to Prisma on Dec. 5 that included significant compromises. Prisma responded nine days later with a proposal that actually moved our organizations farther apart in the negotiation. Prisma continues to demand a more than 20% price hike for our commercial plans that would take effect over the next 12 months, which is not affordable or sustainable for South Carolinians and employers. Prisma's actions indicate it seems intent to go out of network given its repeated demands for outlandish rate increases throughout our negotiation. We remain open to continued discussions should Prisma provide a realistic proposal."
Sattele said she's worried because Tuomey is the closest the hospital for her and her family, and other non-Prisma facilities are too far.
"I would have to either go to Columbia, which is actually closer than Florence. I've timed it; it's like 35 minutes up the road to Columbia and almost 50 minutes to get to Florence," she said.
Chris Johnson with Lourie Life and Health, an independent insurance agency, said people in this situation have solutions. Friday is the last day of open enrollment for healthcare, but Medicare Advantage customers also have some extra time to change.
"There is another window that begins in January. It's called the Medicare Advantage open enrollment period. So, for those people who have a Medicare Advantage plan, they have one opportunity during the months in January, February, March, to change to a different plan," he said.
United Healthcare said new members in the middle of treatment with a Prisma Health provider or those with a serious acute or chronic condition may be eligible for continuity of care; that includes women who are pregnant (second or third trimester) through six weeks post-delivery. And patients with newly diagnosed or relapsed cancer or those currently in active cancer treatment.
Sattele said she's holding onto hope a resolution can be reached for her health.
"I'm hoping they'll settle before the first of the year and we can keep the policies that we have enforced now. It'll be easier for everybody," she said.
Prisma Health declined to comment.