SC’s Prisma locked in legal battle with largest US insurer over patient rates, press statements

Two health care giants are battling over how much some South Carolinians will pay for medical treatment in the coming months, as health care costs continue to soar following strains from the pandemic. And while one contender is accused of using the media to unfairly influence contract negotiations, the other says, essentially: They started this mess.

The legal battle between Prisma Health and insurance provider UnitedHealthcare has shed some light on what cost changes could be coming for South Carolinians covered by the nation’s largest insurer. Some 50,000 South Carolina United customers are caught in the crossfire, as the insurer says their health care costs could rise by as much as 24% over 15 months at a number of hospitals and doctors’ practices come 2024 if the dispute isn’t settled.

Prisma Health is the largest health care provider in South Carolina, a Greenville-headquartered nonprofit that encompasses 18 hospital facilities and more than 300 physician practices across roughly half the state, including three major hospitals in the Columbia area. UnitedHealthcare is the nation’s largest medical insurer that insures some 7 million Americans, including more than 50,000 in South Carolina.

Amid negotiations between Prisma Health and UnitedHealthcare over how much patients insured by United will be required to pay for care at Prisma facilities in South Carolina beginning Jan. 1, 2024, Prisma brought a lawsuit against United on Aug. 23 for making “inflammatory and inaccurate statements to various media outlets regarding the parties’ private business relationship,” in violation of provisions governing contract negotiations between the parties.

But United responded by saying Prisma broke confidentiality first and leaked information to the press by sending an Aug. 16 email directly to United’s 50,000 South Carolina customers, who include some media members covered by United insurance, alerting them of potential significant increases in health care costs as negotiations between the two companies were stalling.

Citing inflation, a shortage of health care workers and supply chain disruptions spurred by the pandemic, Prisma, in its email, told United customers that United needed to “cover their fair share” in order to help offset increasing costs.

United has claimed that Prisma’s email was a “coordinated … media effort to put pressure on UnitedHealthcare Insurance Company and UnitedHealthcare of South Carolina Inc. in the parties’ ongoing contract negotiations,” United said in response to Prisma’s lawsuit.

Some media members from a television station in Greenville received the email from Prisma then contacted United for comment about the communication they’d received. United responded, setting off the chain of legal actions now tying up the two companies.

In its media response, United told an Upstate reporter that “Prisma was demanding a 24 percent price hike over 15 months that would increase health care costs by $63 million,” figures with which Prisma took further issue.

In its lawsuit, Prisma said United’s statement to the media was “misleading to the public” and “a tactless effort to gain an advantage” in their contract negotiations.

But United contended that its statement to the press was accurate and devoid of confidential information regarding negotiations, as “the 24% increase simply represents the four rate increases requested by Prisma in the first 15 months.”

Now that a judge has sided with United against Prisma’s motion to stop United from speaking with the press about ongoing contract negotiations, questions remain as to whether the lawsuit will be dismissed outright in light of an arbitration agreement between the two health care giants.

Although 13th Circuit Court Judge Perry Gravely did not provide a formal order detailing the reason for his decision to deny Prisma’s temporary injunction request, one is expected soon, according to United.

In addition, a ruling on whether Prisma’s lawsuit should be dismissed because of contractual arbitration clauses, alleged by United, hangs in the balance.

In the meantime, health insurance premiums and out-of-pocket costs beginning Jan. 1, 2024, for United customers looking for care at Prisma facilities remain in limbo.

Prisma Health did not respond to a request for comment by The State.