SSM Health

An update regarding our network negotiation with SSM Health

We know many of you continue to see or hear inaccurate information from SSM Health regarding our network negotiation. We understand the stress and uncertainty this creates, and it is not something we take lightly.

Your access to care remains our top priority. We are committed to keeping you informed and want to share the following update:

What’s happening

We continue to actively negotiate with SSM Health to reach an agreement that is affordable while maintaining continued, uninterrupted network access to the health system. Our organizations continue to exchange proposals and are engaged in daily conversations as part of good-faith efforts to reach a solution prior to our contract expiring on Jan. 1, 2026.

We want people to have access to SSM Health. However, we also have a responsibility to ensure that access remains affordable.

Employers and families throughout St. Louis, Jefferson City and the surrounding areas are already struggling to afford skyrocketing health care costs. The leading driver of these increases are the prices hospitals charge—such as SSM Health—which is demanding unsustainable cost increases for our commercial plans, adding even more financial strain for people and employers during challenging economic times.

The majority of the employers we serve throughout the St. Louis and Jefferson City areas self-fund their health insurance plans. When hospitals demand steep price hikes, these employers must make difficult decisions about benefits and costs. We simply administer those plans. When provider costs rise, employers bear the financial risk and often have no other choice than to pass those costs along to employees, resulting in higher deductibles, out-of-pocket expenses, and employee contributions.

SSM Health is also seeking to maintain its high costs that are an outlier for our Medicaid plan in Missouri. The states where we operate our Medicaid plans have asked us to support their efforts to provide quality health care coverage to their residents while also helping to contain rapidly rising health care costs. We take this responsibility seriously and are committed to being a good steward of taxpayer dollars.

Our top priority is to find a solution that works for everyone—including SSM Health. Our goal is to reach an agreement that reimburses SSM Health at market-competitive rates without placing an undue burden on hard-working families, Missouri taxpayers and businesses already struggling with health care costs.

We will stay at the negotiating table as long as it takes to reach an agreement. We hope SSM Health will join us there. Quality care can and should be affordable—and the people and companies we serve deserve both.

While we continue our discussions with SSM Health, our top priority is providing you access to the care you need. We want to remind you of the following:

Continuity of care and how it works:

If you or a loved one is in active or ongoing treatment for a serious or complex condition with an SSM Health provider at the time they leave our network, you may qualify for continuity of care. Continuity of care provides continued in-network benefits for a period of time after a provider leaves our network.

Some examples of conditions eligible for continuity of care include but are not limited to:

  • Patients who are pregnant
  • People currently in active cancer treatment

Please call the number on your health plan ID card if you have questions about continuity of care, including whether you or a family member might be eligible. Our dedicated team of advocates is ready to support you and help answer any questions you might have.

You continue to have access to a robust network of providers

Should SSM Health leave our network, you will continue to have access to a large network of hospitals and physicians in the St. Louis and Jefferson City areas as well as throughout all of Missouri and Illinois that are readily able to provide top-quality care.

If you have questions or need assistance finding alternative providers in your area, please call the number on your health plan ID card. You can also use the provider directory at myuhc.com to search for alternative hospitals and physicians in your area.

What to do in the event of an emergency should SSM Health leave our network

You should go to the nearest hospital in the event of an emergency. Your care will be covered at the in-network benefit level, regardless of whether the hospital participates in our network.

We are negotiating with SSM Health to renew our network relationship for its Missouri and Illinois providers

Our top priority is to reach an agreement that is affordable for Missouri and Illinois families while maintaining continued, uninterrupted network access to the health system. If we are unable to renew our relationship, SSM Health’s hospitals, facilities and its physicians throughout Missouri and Illinois will be out of network for the following plans, effective Jan. 1, 2026:

  • Employer-sponsored commercial plans, including UMR and Surest
  • UnitedHealthcare Community Plan (Medicaid)

People enrolled in Medicare Advantage plans, including Dual Special Needs Plan (DSNP) and Group Retiree, will continue to have network access to SSM Health on and after Jan. 1, 2026

These plans are not impacted by our negotiation. Likewise, people enrolled in a Medicare Supplement plan also continue to have access to SSM Health, on and after Jan. 1, 2026.

Facts you should know

SSM Health issued a notice to end our contract and is seeking unsustainable price hikes that are not affordable for the people and employers we serve

SSM Health’s proposed rate increases for our commercial plans would drive up premiums and out-of-pocket expenses for our members as well as the cost of doing business for local companies.

We are proposing meaningful rate increases for our commercial plans that would continue to reimburse SSM Health at market-competitive rates. 

The majority of the price hikes SSM Health is seeking for our commercial plans would come out of the budgets of self-funded employers

The majority of our commercial members in St. Louis, Jefferson City as well as throughout all of Missouri and Illinois are enrolled in a self-funded commercial plan. Businesses that opt for a self-funded health plan are assuming the risk of paying for their employees’ health care needs. SSM Health’s price hike demands would directly drive up health care costs for these employers.

As the prices for health care continue to rise, these employers have less money available to help grow their business through things like investments in new technologies or increase salaries for employees. 

SSM Health is significantly more expensive than the average cost of all other providers in our Medicaid network in Missouri

SSM Health is reimbursed as much as 40% more than some providers in our Medicaid network in the state, depending on the provider type and location. Allowing our Medicaid contract to remain as is would result in approximately $15 million in additional health care costs over the next year on top of SSM Health’s already-high costs.

The states where we operate our Medicaid plans have asked us to support their efforts to provide quality health care coverage to their residents while also helping to contain rapidly rising health care costs. We take this responsibility seriously and are committed to being a good steward of taxpayer dollars.

SSM Health’s high costs are no longer sustainable for our Medicaid plan. We are asking the health system to work toward a solution that is affordable while reimbursing the health system at market-competitive rates.

SSM Health’s false allegations regarding how we process claims are a distraction from what our negotiation is really about, which is providing people and employers access to affordable care

Our discussions throughout our negotiation have always been focused on reaching an agreement that continues to reimburse SSM Health at market-competitive rates while balancing the need for affordable care for our members and employers.

SSM’s Health’s claims experience is consistent with claims approvals data we've reported publicly

Get the facts: How many claims are denied?
  • At UnitedHealthcare, we approve and pay 90% of claims shortly after they’re submitted. The remaining 10% go through an additional review process.
  • We verify the patient is a UnitedHealthcare member, check for duplicate claims, confirm that the physician has submitted the necessary clinical documentation, ensure the service is a covered benefit, and assess whether the service aligns with the most up-to-date, evidence-based clinical guidelines.
  • After this additional review process is completed, UnitedHealthcare’s claims approval rate stands at 98% for claims for eligible members, when submitted in a timely manner with complete information, and after duplicate claims are removed.

We will remain at the negotiating table as long as it takes to reach an agreement that is affordable for consumers and employers

We know the relationship between people and their doctors is deeply personal and important. We are doing everything we can to reach an agreement and we will remain at the negotiating table as long as it takes. However, we need SSM Health to work with us toward an agreement that is affordable and sustainable for the people and local companies we serve.

Frequently asked questions for our members