HealthPartners said it will drop out of UnitedHealthcare’s Medicare Advantage plan network next year, accusing the nation’s largest health insurer of excessively high rates of denials and frequently delaying payments for services used by seniors.
Bloomington-based HealthPartners, one of the Twin Cities’ largest hospital and clinic operators, sent letters this week to about 30,000 patients about the changes.
The health system says UnitedHealthcare’s practices cause unnecessary wait times and delays for patients and prevent them from receiving proper care.
“UnitedHealthcare has delayed or denied payment authorizations for our patients’ Medicare Advantage claims at rates that are unmatched by any other insurer in our marketplace,” the letter said. “At times, these denial rates have been up to 10 times higher than other insurers with which we do business.”
Through a spokesperson, UnitedHealthcare said it offered the specific contract terms HealthPartners was seeking earlier this year, but that the health system has since retracted that position and is now making false and outlandish claims that insurers denied claims.
The spokesperson also alleged that HealthPartners has sought price increases for employer-sponsored Medicare Advantage plans, making its services more expensive than peer health systems.
“We proposed a contract that provided HealthPartners with the solutions they sought in order to continue participating in our Medicare Advantage network,” UnitedHealthcare said in a statement. “Rather than use the remaining term of the contract to implement these solutions, HealthPartners has now backed out and is putting Medicare Advantage patients in the middle of our negotiations, causing them unnecessary stress and fear while spreading outlandish and false claims.”
HealthPartners will remain in-network through the end of the year, so enrollees don’t need to take any action right now.
But the network changes could be a factor for seniors considering their options this fall during the annual open enrollment period for Medicare Advantage, in which seniors choose to receive their Medicare benefits through private managed care health insurers.
But UnitedHealthcare said there is still time for negotiations.
“Our goal is to utilize the remaining term of the agreement to reach an agreement that provides continued access to the HealthPartners network for the people we serve,” the insurer said in a statement.
UnitedHealthcare and its parent company, Minnetonka-based UnitedHealth Group, have faced a series of questions over the past year or so about their coverage practices and policies. Earlier this month, 11 people were arrested outside UnitedHealthcare’s headquarters in Minnetonka during an event featuring coverage denials.
In November, UnitedHealth Group was hit with a class action lawsuit alleging the company used flawed artificial intelligence algorithms to unfairly block coverage for certain Medicare patients, and in July 2023, the U.S. Department of Labor sued a subsidiary of the company for allegedly making unfair coverage decisions.
HealthPartners is the second-largest nonprofit in Minnesota. Its operations include one of the state’s largest health insurers, and the division competes with UnitedHealthcare in the Medicare Advantage market.
The network changes next year will apply to care provided at HealthPartners and Park Nicolet clinics as well as the nonprofit’s hospitals, including Regions in St. Paul, Methodist in St. Louis Park and Lakeview in Stillwater.
“It is unusual for us to leave a health plan network,” HealthPartners said in a letter to patients. “Unfortunately, after a year of negotiations, we have determined that we can no longer participate in UnitedHealthcare’s Medicare Advantage network.”
HealthPartners announced last summer that it would drop out of Kentucky-based insurer Humana’s network of Medicare Advantage plans in 2024. At the time, the nonprofit did not mention concerns about denial rates in a letter sent to about 13,000 patients.
UnitedHealthcare is the largest Medicare Advantage health insurer in the country. The company has expanded its market share in Minnesota since entering the state’s senior market in 2019. That same year, Humana also gained Medicare Advantage market share in Minnesota, amid declining membership numbers for HealthPartners and two other nonprofit insurers.
While almost all doctors and hospitals participate in Original Medicare, Medicare Advantage plans have a limited network of doctors and hospitals that agree to provide care to seniors with the lowest out-of-pocket costs. These network rules effectively limit options when enrollees can’t afford to pay higher prices for out-of-network care.
Medicare’s open enrollment period runs from Oct. 15 to Dec. 7. According to HealthPartners, it’s the perfect time for individual Medicare Advantage enrollees to explore their options.
The health system says enrollees with UnitedHealthcare Medicare Advantage coverage offered by a former employer should discuss their options with their employer or UnitedHealthcare.
