Effective January 1, 2025, Essentia Health will no longer be serving as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare and Humana.
Essentia is joining a list of so far 24 other health systems, including Sanford Health, in dropping Medicare Advantage plans.
Dr. Cathy Cantor is Essentia’s chief medical officer for population health. She says the frequent denials and associated delays impacted Essentia’s ability to provide care patients need – but it was still a difficult move to make.
"It was a very difficult decision, and one that we don't take lightly, as we know this causes unnecessary stressors and hardships for patients, which really it can already be a stressful time in their life if they've been sick or ill. We've been in talks with United almost a year now about these concerns, about the high denial rates of care, but once we felt that we weren't really getting to the place where aligns with where we are, with keeping the patient at the center of all that we do - we felt it was time to make a decision."
Cantor says Essentia is currently in the process of notifying all patients affected by this change, ahead of the Medicare open enrollment period which runs from October 15 through December 7th. She says she is hopeful this will give them enough time to find alternative plans.
"They've built relationships with their providers, and we'd certainly love for them to stay with their Essentia Health providers. They can opt for a different health plan through Medicare, Medicare Advantage - we accept and work with several health plan providers such as Medica, UCare, EssentiaCare, Blue Cross Blue Shield of North Dakota and Minnesota, as well as traditional Medicare to name a few. We have representatives available who can walk them through that, what that would mean and look like. If they want to stay with their plans through UnitedHealthcare or Humana, then they'll need to select new providers outside of Essentia."
Patients can learn more about this situation online -
UHC patients - essentiahealth.org/UnitedHealthcare
Humana patients - essentiahealth.org/Humana