Health systems across the country are taking a stand against Medicare Advantage plans that they believe are hindering patient care. Essentia Health, a prominent integrated health system based in Duluth, Minnesota, recently announced that it will be terminating its relationships with Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana starting January 1, 2025. The decision was made in response to what Essentia Health describes as excessive prior authorization requirements and a high rate of denial of care from these particular plans.
According to Dr. Cathy Cantor, Essentia Health’s chief medical officer for population health, the frequent denials and delays in approval from UHC and Humana have a significant negative impact on the health system’s ability to provide timely and appropriate care to its patients. Dr. Cantor emphasized that this decision was not made lightly, but rather as a necessary step to ensure that patients receive the quality care they deserve.
Essentia Health is not alone in its decision to end relationships with Medicare Advantage plans. Other provider organizations, such as Sanford Health and HealthPartners, have also cited ongoing challenges and concerns with certain plans as reasons for discontinuing participation. Sanford Health, based in South Dakota, will be ending its relationship with Humana Medicare Advantage at the end of the year, while HealthPartners, located in Minnesota, has already made the decision to cease participation in the UnitedHealthcare Medicare Advantage network.
In a similar move, Mercy, a healthcare provider in Missouri, has provided written notice to end its contracts with Anthem Blue Cross Blue Shield (BCBS). This decision impacts all commercial, Medicare Advantage, Affordable Care Act (ACA) marketplace, managed Medicaid plans, and HealthLink plans under the Anthem BCBS umbrella. Mercy’s senior vice president of population health and president of contracted revenue, Dave Thompson, emphasized the organization’s commitment to safeguarding patients and ensuring they receive high-quality care without unnecessary disruptions.
As more health systems re-evaluate their participation in Medicare Advantage plans, patients are advised to stay informed about any changes that may affect their coverage. It is essential for individuals to understand their healthcare options and consider the implications of these decisions on their access to care.
—
## FAQ
### What are Medicare Advantage plans?
Medicare Advantage plans are offered by private insurance companies as an alternative to traditional Medicare. These plans provide all Medicare Part A and Part B coverage, and often include additional benefits such as prescription drug coverage.
### How can patients affected by these changes find alternative coverage?
Patients affected by changes in provider relationships with Medicare Advantage plans should contact their insurance company to explore other options available to them. It may be helpful to consult with a healthcare provider or insurance advisor for recommendations.
### Will patients experience disruptions in care due to these changes?
Health systems are working to minimize disruptions in care for patients affected by changes in provider relationships with Medicare Advantage plans. Patients are encouraged to communicate with their healthcare providers to ensure continuity of care and explore alternative options if needed.
## Conclusion
The decision of health systems to end relationships with certain Medicare Advantage plans reflects a growing concern over the impact of excessive prior authorization requirements and denial of care on patient well-being. As more provider organizations take a stand against plans that hinder the delivery of quality care, patients must stay informed and proactive in understanding their healthcare options. By advocating for their healthcare needs and exploring alternative coverage options, individuals can navigate these changes with the support of their healthcare providers and insurance professionals.