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Re: UHC-IBM lose large health provider in Florida


 

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The same thing has happened here in South Carolina.? Prisma Health is the largest health care provider in the state, but they have sent me many emails and letters since about the beginning of September that starting January 1, 2024, UHC will be out of network.? Lately, they have been upping the ante by notifying me of all the different health plans they do accept, and urging me to switch to one they accept.? They have also specified every Prisma doc, nurse practitioner, and physical therapist I’ve been to in the last 10 years, to let me know they will be out-of-network next year unless I switch to a new plan.

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This is the second time in the 10 years since I’ve lived her in SC this has happened.? Even before the IBM UHC plan was announced about a year ago, I had already been on UHC plans for many years.? Eventually a month or two into the new year, they come to an agreement and I can go back to the Prisma docs without them being out-of-network.? UHC has a history of demanding ever higher reimbursements so they can maintain their fat profit margins.

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From: [email protected] <[email protected]> On Behalf Of Michael Halliday via groups.io
Sent: Monday, December 4, 2023 9:39 AM
To: [email protected]
Subject: [ibmpension] UHC-IBM lose large health provider in Florida

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HC wrote to me, warning that my health provider will go out of network in 2024. They said, in part "Your plan will cover care from Sarasota Memorial Health Care System (SMH) as an out-of-network provider, if they are a Medicare-approved provider and accept the plan. Your share of the cost will be the same as if they were part of the network."

Sound comforting? Not so. The devil is in the details. SMH told me they will NOT accept UHC in 2024 - not even out-of-network. So I must change all my doctors next year, or return to an Aetna Advantage plan (which IS accepted by SMH), and lose the IBM subsidy.

I wonder if anyone knows exactly how out-of-network with same copay even works with UHC. Without a contracted rate, how much would the provider bill UHC?? Their full rate? I find it hard to believe that UHC would swallow the difference between full rate and Medicare "usual & customary" (less my copay).

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