HealthPartners said it will drop out of the network for UnitedHealthcare Medicare Advantage plans next year because it claims the nation’s largest health insurer has too high a coverage denial rate and often delays payment for services used by seniors.
Bloomington-based HealthPartners, one of the largest operators of hospitals and clinics in the Twin Cities, is sending letters about the change to about 30,000 patients this week.
The health system says UnitedHealthcare’s practices cause patients to endure unnecessary waits and delays that hinder access to appropriate care.
“UnitedHealthcare delays and denies approval of payments for our patients’ Medicare Advantage claims at a rate that is lower than any other insurer in our market,” the letter states. “At times, this denial rate is as much as 10 times higher than other insurers we work with.”
UnitedHealthcare said through its spokesperson that it offered some of the contract terms sought by HealthPartners earlier this year, but the health system later backed away from its position. UnitedHealthcare said HealthPartners is now making false and outlandish allegations about the insurer’s denial of claims.
The spokesperson also alleged that HealthPartners has sought price increases for employer-sponsored Medicare Advantage plans, which would make its services more expensive than those of comparable health systems.
“We proposed a contract that provided solutions for HealthPartners to continue participating in our Medicare Advantage network,” UnitedHealthcare said in a statement. “Instead of using the remaining time of our contract to implement these solutions, HealthPartners withdrew its position and is now putting Medicare Advantage patients in the middle of our conversations, unnecessarily creating stress and fear for them while spreading bizarre, false claims.”
HealthPartners will remain in the network through the end of the year, so customers don’t need to take any action yet.
Network changes, however, could be a factor as seniors consider their options in the annual open enrollment period for Medicare Advantage coverage this fall. With these Advantage health plans, seniors choose to receive Medicare benefits through a private managed care health insurer.
However, UnitedHealthcare said there is still time for negotiations.
“Our goal is to use the remaining months of our contract to reach an agreement that ensures the people we serve have continued in-network access to HealthPartners,” the insurer said.
UnitedHealthcare and its parent company, Minnetonka-based UnitedHealth Group, have faced numerous questions about coverage practices and policies over the past year. This month, 11 people were arrested outside the Minnetonka headquarters during an event to highlight coverage denials.
In November, UnitedHealth Group was hit with a class action lawsuit claiming the company used a faulty artificial intelligence algorithm to unfairly withhold coverage for some Medicare patients. In July 2023, the US Department of Labor sued a subsidiary of the company over allegations of incorrect coverage decisions.
HealthPartners is Minnesota’s second-largest nonprofit group. Its operations include one of the state’s largest health insurance companies, which competes with UnitedHealthcare in the Medicare Advantage market.
The network change next year applies to HealthPartners and Park Nicollet clinics, as well as the nonprofit group’s hospitals, which include 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 its patients. “Unfortunately, after a year of negotiations, we have decided we can no longer participate in the UnitedHealthcare Medicare Advantage network.”
Last summer, HealthPartners announced it would drop out of networks for Medicare Advantage plans from Kentucky-based insurer Humana in 2024. In that case, the nonprofit did not mention concerns about denial rates in letters it sent to about 13,000 patients.
UnitedHealthcare is the nation’s largest Medicare Advantage health insurer. The company has grown its market share in Minnesota since entering the market for seniors here in 2019. That year, Humana also gained Medicare Advantage market share in Minnesota amid membership declines at HealthPartners and two other nonprofit insurers.
Nearly all doctors and hospitals are part of original Medicare, but Medicare Advantage plans have a limited network of doctors and hospitals that agree to provide care to seniors at the lowest cost. If enrollees cannot afford the higher fees associated with out-of-network care, these network rules effectively limit options.
Open enrollment for Medicare runs from October 15 through December 7. According to HealthPartners, this is the best time for people with individual Medicare Advantage coverage to consider options.
The health system says people with UnitedHealthcare Medicare Advantage provided by a former employer should discuss options with their employer or UnitedHealthcare.
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