Premier out as in-network provider for CareSource

June 14--CareSource will stop paying Premier Health hospitals and providers for most services covered by its Just4Me private health plans after Aug. 1, CareSource said Monday.

Instead, the downtown Dayton-based Medicaid managed care provider and commercial health insurer has signed a new agreement with Kettering Health Network to provide services for members of its Just4Me plans sold under the Affordable Care Act.

CareSource officials cited plan costs as the reason for the switch, which will not affect CareSource's Medicaid members who continue to use the Premier provider network.

"In January, we were made aware of Premier's decision to significantly increase 2017 health care costs for our CareSource Just4Me membership," said Steve Ringel, president of CareSource's Ohio market. "In partnership with Kettering Health Network, CareSource will be able to offer high quality health care and affordable premium rates for our members."

CareSource has 7,000 members who have the Just4Me insurance plan in the Dayton service area. About 400 of those members have used or been assigned to Premier providers in the past 12 months, the company said.

"We spoke with CareSource in good faith. Despite that, there were contract changes requested by CareSource that we were not able to accept, and CareSource terminated the contract," said Diane Ewing, a Premier spokeswoman.

After Aug. 1, Just4Me plans -- which CareSource launched in 2013 under the Affordable Care Act -- will continue to pay for covered services at Premier facilities for certain policyholders, including people with terminal illnesses who may continue to see their Premier providers indefinitely, and women in their second or third trimester of pregnancy who may continue to see their physician through postpartum visits, according to a notification letter from the company.

Policyholders in active care plans may also continue to receive services from Dayton-based Premier, which also sells its own individual health coverage under the ACA through Ohio's health insurance marketplace.

Prior authorization from CareSource will be required for all policyholders who continue care from Premier providers after the Aug. 1 deadline. Just4Me members with questions can contact member services at 844-539-1730.

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