United Healthcare excludes UF Health from its provider network

~ Thousands of patients prevented from accessing nationally recognized academic health system ~

University of Florida (UF) Health News
By Greg Harrison

Gainesville, Florida — Despite months of earnestly negotiating in good faith for fair and appropriate rates for hospitals, physicians, and other providers, as of September 1, 2024, United Healthcare is excluding UF Health hospitals and physician groups in Gainesville, Jacksonville, and St. Johns, Florida from its network. The action prevents thousands of patients with United Healthcare commercial and Medicaid Managed Care plans from accessing compassionate, leading-edge care at UF Health locations in all three markets, and Medicare Advantage patients in the St. Augustine, Florida area.

“We are sensitive to the challenges this poses for our patients and despite the outcome we continue to earnestly work with United Healthcare toward a solution. Our commitment to placing patients at the heart of our efforts is unwavering, and we have put processes in place to minimize any disruption in care to the extent we can, but unfortunately United Healthcare has given us no other choice,” said Marvin Dewar, M.D., J.D., chief executive officer of UF Health Physicians. “We even invited United leadership to meet with us on site to finalize the agreement, but they declined. We continued to try to reach an agreement, right up to the deadline, but United insisted upon linking other products to the negotiations and abruptly imposing new conditions and changing language to items that had already been agreed upon. As a physician, my job is to care for my patients, and we did our best to avoid this situation.”

UF Health has been striving to fulfill its mission of caring for patients and the communities it serves while managing continual double-digit increases in labor, supply, and other expenses. However, United offered UF Health commercial rates that are below general inflation and far below rising annual costs. United was paying UF Health considerably less than market rates, and those numbers have been declining throughout the past several years. To make matters worse, they offered no increase to UF Health’s physician practices for the coming 12 months.

Worse yet, United also has refused to honor their commitment to pay rates previously agreed to. Complex and lengthy prior authorization processes, complicated billing and coding requirements, and claim denials/payment delays have led to reductions in reimbursement to UF Health. This results in payments that are significantly less than other Managed Medicaid payors.

“As the state’s leading academic health system that researches leading-edge treatments, educates future generations of clinicians, and treats a disproportionate number of underserved patients, we deserve to be paid fairly and competitively for the care we provide to patients and the services we offer,” Dewar said. “Reasonable compensation is necessary for us to sustain our mission.”

UF Health has made thorough arrangements to continue to care for patients with urgent care needs, such as pregnancies, nonelective surgeries, emergency medicine, and cancer care, and for those requiring other services such as behavioral health and transplants. Except for patients seeking care with UF Health, St. Johns, Medicare Advantage patients are not affected. UF Health Central Florida is not part of these current negotiations and remains in network with United Healthcare.

University of Florida students who have a United Healthcare plan through the university’s student health insurance program will be able to continue to receive care at the UF Student Health Care Center and at all UF Health facilities, just as they always have, with no adverse impacts.

For students who have United Healthcare coverage through their parents’ insurance, instead of through the university’s student health insurance program, UF and UF Health will ensure they will continue to be able to receive service at the Student Health Care Center location just as they always have, with no changes in co-pays or deductibles. Unfortunately, services at other UF Health locations are now out of network for this subgroup.

“We are committed to doing our part to reach an agreement that would prevent disruption to all our patients’ continued access to UF Health physicians and facilities for non-emergency services and care,” Dewar said. “We are continuing to negotiate in good faith, but we are waiting for the health plan to respond with a fair and sustainable offer to make that happen. Again, this includes streamlining their claims process and reducing administrative demands.”

Patients can contact UF Health with questions at 1-855-834-7337 or 352-265-8585. For answers to frequently asked questions, and a list of health plans accepted by UF Health in Gainesville and Jacksonville, visit https://UFHealth.org/healthplans. For answers to frequently asked questions and health plans accepted at UF St. Johns, visit https://StJohns.UFHealth.org/UHC.

United Healthcare patients are encouraged to talk to their benefits managers or brokers or call United. Most insurance companies list their patient customer service numbers on membership identification cards. Some customer service numbers United Healthcare lists on their website include:
Commercial: 1-866-801-4409
Medicaid Managed Care: 1-888-716-8787
Medicare Advantage: 1-855-893-5505

UF Health will continue to provide updates on progress as negotiations continue.