Hospital employees' health plan in limbo

Medical Mutual of Ohio’s decision to drop Premier Health Partners from its network has left one Premier hospital, Upper Valley Medical Center, in limbo.

Medical Mutual is the sole third-party administrator of the Miami County health system’s self-insured health plan.

Mike Maiberger, UVMC’s president and CEO, said in a prepared statement Wednesday, Nov. 11, that UVMC is in the process of putting a plan in place “to ensure that UVMC employees will have the same, or a very similar, health insurance plan with another third-party administrator in the event that we are unable to reach an agreement with Medical Mutual.”

UVMC is Miami County’s largest employer. The decision affects 1,120 UVMC employees, plus 12 retirees who received health-care benefits as part of an early-retirement package in the 1990s. Employees were told of the decision Tuesday through a newsletter, hospital spokeswoman Gail Peterson said.

Medical Mutual confirmed Tuesday that it is terminating its agreement with Premier as of Jan. 1, 2010.

Ed Byers, Medical Mutual’s manager of media relations, said Wednesday that no plans to resume negotiations with Premier have been made. Medical Mutual received about 100 calls Wednesday from Dayton-area members seeking more information, he said. Medical Mutual members may call (877) 328-6664.

Premier spokeswoman Diane Ewing had said Tuesday that Premier’s proposed reimbursement rate for Upper Valley Medical Center was significantly less than those proposed for Premier’s other three hospitals: Miami Valley and Good Samaritan hospitals, and Atrium Medical Center. On Wednesday, Ewing said the lower proposed reimbursement rate for UVMC was not related to the fact that Medical Mutual is UVMC’s sole third-party administrator.

Medical Mutual is the third insurer to drop Premier Health Partners in the past five years. Humana Inc. dropped Premier a year ago, and Premier and Anthem were separated for one year after a contract showdown in late 2004. Premier rejoined the Anthem network in 2006.