UnitedHealthcare and Essentia Health announced an agreement Friday for the Duluth-based health system to keep participating in the insurance company’s Medicare Advantage network next year, affecting about 10,000 patients.
UnitedHealthcare, Essentia Health agree to network contract for 2025
The Duluth-based health system alleged earlier this year high rates of denied claims and payment delays by the nation’s largest health insurer.
The Minnesota Star Tribune
November 9, 2024 at 12:24AM
The resolution marks the second agreement struck this week by Minnetonka-based UnitedHealthcare, which announced Tuesday a 2025 network contract with Bloomington-based HealthPartners.
Similar to HealthPartners, Essentia Health announced earlier this year the health system would go out of network for UnitedHealthcare Medicare Advantage patients due to what it described as high rates of denied claims and payment delays, as well as the insurer’s prior authorization requirements.
“We realize that the uncertainty of this situation was difficult for many of the patients we’re honored to serve,” Dr. Cathy Cantor, Essentia’s chief medical officer for population health, said Friday in a prepared statement. “We felt strongly that it was important to advocate for our patients, and we were able to reach an agreement for 2025 that addresses many of our issues and concerns by improving timely and reliable access to the high-quality care they depend on from Essentia.”
Essentia Health said Friday it still plans to go out of network next year with Medicare Advantage plans from Kentucky-based Humana.
With 14 hospitals and 78 clinics, Essentia Health has operations in Minnesota, North Dakota and Wisconsin. UnitedHealthcare is the nation’s largest health insurer.
This fall’s Medicare open enrollment period has been unusual in Minnesota for the number of contract impasses that have complicated health plan choices for seniors. Beyond Essentia, three other health systems with operations in the state have announced they’ll go out of network next year with Humana as well.
UnitedHealthcare said the contract agreement with Essentia announced Friday applies to Medicare Advantage plans for individuals as well as retiree groups.
Hospitals and clinics at Essentia also will be in network in 2025 for the company’s employer health plans, Medicaid coverage in Wisconsin and what’s known as a “dual special needs” plan for people who qualify for both Medicare and Medicaid, UnitedHealthcare said.
The complaint marks the second time since 2022 that DOJ has challenged deals in the Minnetonka-based company’s Optum division for health care services.
