UnitedHealthcare corporate headquarters in Minnetonka, Minnesota. Photo: Ken Wolter/Shutterstock
Prisma Health, a South-Carolina-based health system, alleges in a lawsuit filed Aug. 23 that UnitedHealthcare breached the parties' confidentiality agreement and provided inaccurate statements to the media about Prisma's proposed rates for 2024. The suit claims that UnitedHealthcare undermined good-faith negotiations by issuing multiple statements to the media without providing advance notice to Prisma.
Prisma sought a temporary restraining order to prevent United from divulging any further third party proprietary business information and is asking the court to require UnitedHealthcare to retract its previous media statements. Prisma alleged the insurer issued "false and misleading" statements in a "bad faith attempt to gain leverage during negotiations."
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Both companies last negotiated contract terms in 2021. Since that time, the United States has experienced record inflation, which providers argue has driven up the cost of care. The nonprofit health system and insurer have been negotiating new rates throughout this year in an effort to keep Prisma as an in-network provider for thousands of South Carolinians. The three-year contract is set to expire at the end of December.
"Prisma Health is demanding a 24% price hike over 15 months that would increase health-care costs by $63 million, with more than $46 million coming from the budgets of self-funded employers," UnitedHealthcare said in a statement. "We are committed to utilizing the remaining four-plus months on our contract to engage in productive, good-faith negotiation with the goal of renewing our relationship. We urge Prisma to work with us and to provide a realistic proposal that is affordable for the South Carolinians and businesses we serve."
In a recent letter to members, Prisma Health said that beginning Jan. 1, 2024, unless Prisma can reach new agreements, UnitedHealthcare no longer will include Prisma Health as an in-network provider. The health system asked that UnitedHealthcare publicly acknowledge that "the cost of health care has increased since the execution of the last agreement in November of 2021" and that Prisma did not "demand a 24% increase in reimbursement rates for every contract between the parties."
On Aug. 31, a judge granted Prisma's request for a temporary injunction, preventing UnitedHealthcare from disclosing additional information regarding their negotiations. In response to Prisma Health's lawsuit, UnitedHealthcare says it did not breach its contract with Prisma, which "coordinated a media effort to put pressure" on the insurer. The case is ongoing.
Related: U.S. Labor Department sues UnitedHealth Group subsidiary over denied claims
The suit is the latest example of negotiations gone awry between health systems and insurers. In late August, Bon Secours sued Anthem Blue Cross Blue Shield for $93 million over unpaid claims, a suit a BCBS spokesperson said was "another attempt to distract from Bon Secours' decision to leave Anthem's provider network." The spokesperson said Bon Secours was attempting to negotiate double-digit price increases.
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
