Essentia Health is set to exit UnitedHealthcare and Humana's Medicare Advantage health insurance network next year, a move that will affect about 14,000 Minnesota seniors.
The Duluth-based health system's announcement Tuesday marks the third large health system operating in Minnesota to end network relationships with Medicare Advantage health plans in recent months, all citing concerns about coverage denials and delayed payments.
While the impacts vary, seniors typically have limited access to out-of-network doctors, clinics and hospitals. They may face significantly higher out-of-pocket costs or out-of-network health systems may not schedule appointments for patients insured by their health insurer.
“Comparing UnitedHealthcare to Humana, they have more than twice the rate of treatment denials and delays compared to other Medicare Advantage plans,” Dr. Cathy Kanter, chief medical officer for population health at Essentia, said in an interview. In an online notice to patients, the health system also described “excessive” prior authorization requirements by insurers and said such rules could delay care.
UnitedHealthcare announced in a statement Tuesday that it has extended its contract with Essentia Health for existing Medicaid, Medicare Advantage and employer-sponsored health plans through the end of 2024. As part of the extension, the company said it “agreed to items to collaborate,” an apparent reference to Essentia's concerns about denials and prior authorizations, though UnitedHealthcare said none of those issues are specific to Medicare Advantage.
“In fact, Essentia Health had not expressed any concerns about its participation in our Medicare Advantage network until last week,” the insurer said. “We met with Essentia on Sept. 9 and are committed to working with the health system to explore a solution with the goal of rebuilding our relationship. We hope that Essentia shares our determination to reach an agreement.”
Essentia Health said it will remain in UnitedHealthcare's network next year to serve patients with employer-sponsored health insurance and Medicaid in Wisconsin.
Humana said in a statement that it is “in good faith discussions with Essentia Health to consider the possibility of renewing the contract if it is fair to both parties.”
