DULUTH, Minn. — Essential Health is planning to no longer serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare and Humana, as of Jan. 1 2025.
In a press release Tuesday, Essentia Health said it comes down to UnitedHealthcare and Humana delaying and denying approval of care at "more than twice the rate of other Medicare Advantage plans." An estimated 20,000 patients will be impacted, including 14,000 in Minnesota.
"Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place added strain on our patients by too often denying or delaying their care," said Dr. Cathy Cantor, Essentia's chief medical officer for population health in a press release.
Cantor added that this decision was not "made lightly" and that because of frequent denials "this is the right thing to do for the people we are honored to serve."
In a statement, a UnitedHealthcare spokesperson said:
"We extended our contract in July 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, agreed to items on which we’d collaborate – none of which were specific to Medicare Advantage. Essentia Health didn’t raise 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 toward reaching an agreement."
HealthPartners made a similar announcement earlier this summer, saying their decision came after a year of negotiations.
"UnitedHealthcare delays and denies approval of payment for our patients’ Medicare Advantage claims at a rate unlike any other insurer in our market. At times, this denial rate has been up to 10 times higher than other insurers we work with. UnitedHealthcare’s practices create unnecessary waits and delays for you, and they interfere with our ability to provide you with timely and appropriate care," the July press release stated.
Essentia Health said on Tuesday that patients with UnitedHealthcare or Humana Medicare Advantage plans can find an alternative option during Medicare open enrollment, which goes from Oct. 15 through Dec. 7.
Essentia Health operates healthcare facilities in Minnesota, Wisconsin, and North Dakota.