NMHS terminates UHC Medicare Advantage contract

TUPELO – After nearly a year of negotiating, North Mississippi Health Services facilities and providers have terminated, as of May 31, agreements with United Healthcare Medicare Advantage, as well as Medicaid-required Dual Special Needs Medicare Advantage plans.

For all on these United Healthcare Advantage plans, NMHS providers and facilities are now out of network.

NMHS will remain in network for UHC commercial- and employer-sponsored plans. This change does not impact a vast majority of independent providers.

It is crucial for those on these plans to know if their plan is a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization) — it makes a difference. If your UHC Medicare Advantage plan is a PPO, that means the plan offers out-of-network benefits, and NMHS can continuing offering its services. But if your UHC Medicare Advantage plan is an HMO, the plan does not include out-of-network benefits.

If you are not certain if your UHC Medicare Advantage plan is an HMO or a PPO, your card has the information. Look carefully — it's there.

Each fall there is an annual enrollment period for making changes to Medicare. However, from January through March, seniors who purchased an Advantage plan but may not have been clear on its benefits, may switch plans or return to traditional Medicare, if they desire.

Those with dual eligibility, having both Medicare and Medicaid, can make changes every month and are not locked into an entire calendar year.

"Advantage plans are a good solution for many people," said Wally Davis, vice president of NMHS Payor Strategy & Partnerships. "However, it's always important to fully understand both your in-network and out-of-network benefits."

For those who have serious illnesses that require ongoing care, such as cancer, diabetes or kidney dialysis, and wish to continue with their current NMHS provider may request an exception from United Healthcare.

"This is true for members with both HMO and PPO plans," Davis said. "And each request is considered on a member-by-member basis. Continuity of care may be for 90 days or until the end of specific treatment."

NMHS's termination of the agreement with UHC was based on the fact patients on their Advantage plans were experiencing delays or denials of care.

"We notified UHC Medicare Advantage leadership about this concern in February 2024," Davis said. "Plans denied, on average, 25 to 30% of inpatient claims with North Mississippi Medical Center-Tupelo each month. Despite following the labor-intensive appeals process and achieving an overturn rate of 80 to 85%, we never received from UHC a definitive answer on why this was happening."

For more information about Medicare coverage options, call 1-800-MEDICARE, visit medicare.gov or speak with a local insurance agent or broker. To research plans that NMHS remains contracted with, visit nmhs.net/medicare.

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