Essentia Health announced it will leave Medicare Advantage health insurance networks at UnitedHealthcare and Humana in 2025. This move will affect about 14,000 seniors in Minnesota. Dr.
Cathy Cantor, chief medical officer for population health at Essentia Health, said, “When we looked at UnitedHealthcare and Humana, they deny and delay at rates more than twice that of our other Medicare Advantage plans.” The health system also pointed out “excessive” prior authorization requirements by the insurers, saying these rules can delay treatment. UnitedHealthcare and Humana responded by expressing hopes to negotiate deals to keep Essentia Health in-network. UnitedHealthcare said, “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.”
Essentia Health runs 14 hospitals and 78 clinics across Minnesota, North Dakota, and Wisconsin. The health system is notifying roughly 20,000 patients who’ve visited its facilities in the past 18 months about the changes. The network exits announced by Essentia won’t take effect until Jan.
Essentia Health exits Medicare networks
1, so patients won’t see any change for the rest of this year in their access to doctors, clinics, and hospitals. Essentia Health says seniors in Medicare Advantage plans from Humana and UnitedHealthcare will still have access to emergency rooms within Essentia Health but won’t be able to schedule appointments at Essentia facilities.
In its online notices, Essentia suggests seniors with a Humana or UnitedHealthcare Medicare Advantage plan can switch to a new insurance option during the annual open enrollment period, which runs from Oct. 15 through Dec. 7.
Or, patients can keep their current insurance and choose to see different in-network providers. “This was not a decision we made lightly,” Cantor said in a news release. “The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve.”
Essentia Health was the eighth-largest nonprofit group in Minnesota in 2022, with revenue for that fiscal year of $2.62 billion.
Letters detailing the changes have been posted to online patient charts and are being mailed this week.
- StarTribune.”Essentia Health to drop from Medicare Advantage networks at UnitedHealthcare, Humana”.
- Newsweek.”More Than 500,000 Americans Set to Lose Their Medicare Advantage Plans”.
- DuluthNewsTribune.”Essentia to drop some Medicare Advantage plans”.