Essentia Health To Drop Medicare Advantage Plans With UnitedHealthcare, Humana

Essentia Health is dropping in-network coverage for 20,000 patients who have Medicare Advantage plans through UnitedHealthcare and Humana.

Essentia said those two companies are too often “denying or delaying” patient care at more than twice the rate of other Medicare Advantage plans.

“This was not a decision we made lightly. The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve,” said Dr. Cathy Cantor, Essentia’s Chief Medical Officer for Population Health. “This is the right thing to do for the people we are honored to serve.”

Essentia said patients can choose alternative options during Medicare open enrollment between October 15 and December 7.

Humana replied to this story with the following statement:

“Humana strives to provide access to high-quality healthcare for our health plan members while minimizing out-of-pocket costs. Essentia Health’s decision is surprising, but we are open to good-faith discussions with them and the possibility of renewing the contract if it’s fair to both sides. Humana maintains a network of high-performing providers that will help ensure our members continue to receive high-quality, effective, and affordable care.”

UnitedHealthcare replied to this story with the following statement:

 “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.”