The trend of health systems ending relationships with Medicare Advantage plans continues, and Essentia Health has informed patients that due to excessive prior authorization requirements and denial of care, it will no longer serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana, effective January 1, 2025.
Essentia Health, based in Duluth, Minnesota, is an integrated health system with 14 hospitals serving patients in Minnesota, North Dakota and Wisconsin. It says 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 hardship for many Essentia patients, it says.
“Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place additional strain on our patients by too frequently denying or delaying their care,” Cathy Cantor, MD, MBA, Essentia’s chief medical officer for population health, said in a statement. “This was not a decision we made lightly. 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 issued the following statement: “In July, we extended our contract 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, we agreed to points on which we would collaborate, none of which were specific to Medicare Advantage. Essentia Health did not raise any 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 to reaching an agreement.”
Other provider organizations are taking similar steps. South Dakota-based Sanford Health recently announced it will stop participating in Humana Medicare Advantage on Dec. 31 due to “ongoing challenges and concerns that negatively impact patients, including continued denials of coverage and delays in accessing care.”
Minnesota-based HealthPartners made a similar announcement earlier this summer, saying that “our ongoing reviews found that UnitedHealthcare delays and denies approval of payment for our patients’ Medicare Advantage claims at an exceptionally high rate that can sometimes be up to ten times higher than other insurers we work with. After more than a year of failing to persuade UnitedHealthcare to change its practices, we have determined that we can no longer participate in UnitedHealthcare’s Medicare Advantage network.”
HealthPartners includes a multidisciplinary practice group of more than 1,700 physicians who care for patients in more than 90 clinics and seven hospitals in the Twin Cities and western Wisconsin.
Separately, after months of negotiation with Anthem Blue Cross Blue Shield (BCBS), Mercy has sent a written notice to end its contracts with Anthem in the state of Missouri. These contracts include all commercial plans, Medicare Advantage, Affordable Care Act (ACA), managed Medicaid plans (Healthy Blue), and HealthLink (which falls under the Anthem BCBS umbrella).
“We remain focused on protecting our patients and ensuring they receive the high-quality, low-cost care they deserve with insurance coverage that provides the most protection for their health,” Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue, said in a statement. “We know this news will be concerning to 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 for our patients at the end of the year, particularly those patients who need extended, coordinated care. However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the state’s largest health system, will be in the plan they purchase.”
