Essentia Health on 32nd Ave. S in Fargo (KFGO file photo)
FARGO (KFGO) – Essentia Health will no longer accept Medicare Advantage insurance plans administered by UnitedHealthcare and Humana.
Essentia has started to inform patients that, due to excessive prior authorization requirements and denial of care, it will no longer serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana, effective Jan. 1, 2025.
UHC and Humana delay and deny approval of care for our patients at more than twice the rate of other Medicare Advantage plans. This can cause unnecessary hardships for many Essentia patients.
“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.
Those with a UHC or Humana Medicare Advantage plan can choose an alternative option during Medicare open enrollment, which goes from Oct. 15 through Dec. 7. Patients are encouraged to verify that any new plan is in-network with Essentia to prevent gaps in care. Alternative in-network Medicare plan options include Medica, UCare, EssentiaCare, Blue Cross Blue Shield of Minnesota and North Dakota, HealthPartners, Security Health, traditional Medicare and Medicare supplemental plans.
“This was not a decision we made lightly,” Dr. Cantor said. “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.”
Essentia is notifying all patients affected by this change and will work with them to ensure continuity of care. If they have questions, patients can speak with an Essentia representative by calling (800) 985-4675 between 8 a.m. and 5 p.m. Monday through Thursday or 9 a.m. and 4:30 p.m. on Fridays.
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