The trend of health systems ending relationships with Medicare Advantage plans continues, with Essentia Health informing patients that, due to excessive prior authorization requirements and denial of care, it will no longer will serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana, effective Jan. 1, 2025.
Duluth, Minn.-based Essentia Health is an integrated health system with 14 hospitals serving patients in Minnesota, North Dakota, and Wisconsin. It says that UHC and Humana delay and deny approval of care for its patients at more than twice the rate of other Medicare Advantage plans. This can cause unnecessary hardships for many Essentia patients, it claims.
"Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place added strain on our patients by too often denying or delaying their care," said Cathy Cantor, M.D., M.B.A., Essentia’s chief medical officer for population health, in a statement. "This was not a decision we made lightly. The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve."
As KARE11 reported, UnitedHealthcare issues the following statement: "We extended our contract in July with Essentia Health for our existing Medicaid, Medicare Advantage, and employer-sponsored health plans through the end of 2024, and as part of that extension, agreed to items on which we’d collaborate – none of which were specific to Medicare Advantage. Essentia Health didn’t raise concerns regarding its participation in our Medicare Advantage network until last week. We have since met with Essentia on Sept. 9 and are committed to working with the health system to explore solutions with the goal of renewing our relationship. We hope Essentia shares our commitment toward reaching an agreement.”
Other provider organizations are making similar moves. South Dakota-based Sanford Health recently announced it will end participation with Humana Medicare Advantage on Dec. 31 due to “ongoing challenges and concerns that negatively affect patients including ongoing denials of coverage and delays accessing care.”
Minnesota-based HealthPartners made a similar announcement earlier this summer, saying “our ongoing reviews found that UnitedHealthcare delays and denies approval of payment for our patients’ Medicare Advantage claims at an exceptionally high rate that, at times, can be up to 10 times higher than other insurers we work with. After over a year of being unable to persuade UnitedHealthcare to change their practices, we've determined that we can no longer participate in the UnitedHealthcare Medicare Advantage network.”
HealthPartners includes a multispecialty group practice of more than 1,700 physicians, serving patients at more than 90 clinic locations and seven hospitals throughout the Twin Cities and Western Wisconsin.
Elsewhere, after months of negotiation with Anthem Blue Cross Blue Shield (BCBS), Mercy has provided written notice to end its contracts with Anthem in the state of Missouri. These contracts include all commercial, Medicare Advantage, Affordable Care Act (ACA) marketplace, managed Medicaid plans (Healthy Blue) and HealthLink (which falls under the Anthem BCBS umbrella).
“Our focus remains on safeguarding our patients and ensuring they receive the low-cost, high-quality care they deserve with insurance coverage that provides the greatest amount of protection for their health,” said Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue, in a statement. “We know this news will be concerning for hundreds of thousands of Mercy patients with Anthem BCBS. We will continue to negotiate in good faith with Anthem in hopes of avoiding any disruption to our patients at the end of the year – particularly those patients in need of prolonged, coordinated care. However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the largest health system in the state, will be in the plan they purchase.”
