Insurance rift to hit public retirees

Unless agreement is reached, Atrium won't be able to accept Medical Mutual as in-network.

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By Ben Sutherly  and Jessica Heffner, Staff Writers 10:47 PM Wednesday, November 18, 2009

Edward and Ginger Seamon of Middletown took pride in the new Atrium Medical Center, volunteering there regularly.

But the Seamons — he a retired principal and she a retired teacher — now find themselves in a fix: After Jan. 1, should they need hospitalization, they can’t be admitted at Atrium without paying cost-prohibitive, out-of-network rates.

That’s because Medical Mutual of Ohio said last week it’s terminating its agreement with Premier Health Partners, whose hospitals include Miami Valley and Good Samaritan hospitals, and Atrium. Medical Mutual said it won’t accept Premier’s proposed reimbursement rates.

“It’s very ironic that we can’t use it (Atrium),” said Ginger Seamon. She and her husband, who is about to receive a volunteer service award from the hospital, plan to stop volunteering there at year’s end.

The Seamons aren’t alone. Public-sector retirees throughout the region will be affected if Premier Health Partners is no longer part of Medical Mutual’s network.

In 2010, a Medical Mutual plan is the only option available for State Teachers Retirement System retirees 65 and older not enrolled in Medicare parts A and B, as well as for retirees younger than 65, STRS spokeswoman Laura Ecklar said. (The Seamons don’t have Medicare part A).

The impact will be felt primarily in retirees’ access to hospitals, not doctors, Ecklar said.

Patricia Montgomery, also a retired teacher, said she paid $19,000 out of pocket for her medical expenses. Those costs likely will double if she uses a hospital like Atrium that is not in-network. All of her doctors only have privileges to work at Premier hospitals, including Atrium, which is mere miles from her home in the Hunter area of Franklin Twp. “I need my doctors. I don’t know what I am going to do if I need to ever be hospitalized,” she said.

Ecklar couldn’t say how many STRS beneficiaries would be affected by the pending rift.

Medical Mutual members may call (877) 328-6664 for information.

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