North Mississippi Health Services ends United Healthcare Medicare Advantage contract

United Healthcare Medicare Advantage plans are no longer in-network at North Mississippi Health Services after the health system terminated its contract for the health insurance plans, which largely provide coverage to elderly patients, on June 1.

The decision came after over a year of negotiations between the Tupelo-based system, which operates eight hospitals and over 70 primary and specialty care clinics in North Mississippi, and United Healthcare, the nation's most profitable health insurance company.

About 17,000 United Healthcare Medicare Advantage members live in North Mississippi Health Services' 24-county service area, the vast majority of whom are existing patients, according to Wally Davis, the health system's vice president of payor strategy and partnerships.

Other United Healthcare plans, including commercial and employer-sponsored, Marketplace, Medicaid and CHIP plans, will remain in-network. The change will apply to Medicaid-required Dual Special Needs Medicare Advantage plans.

North Mississippi Health Services alerted patients that it planned to terminate its agreement for United Healthcare Medicare Advantage plans in February, but had until the end of May to negotiate with the company and reach a final decision.

The health care system terminated its agreement with United Healthcare because Medicare Advantage inpatient claims were frequently delayed or denied, Davis told Mississippi Today.

The problem has worsened since the health care system first raised the issue with United Healthcare last year, he said. Last month, 42% of inpatient claims at North Mississippi Medical Center-Tupelo were initially denied, up from 17% in February 2024. The hospital is the only Level II trauma center in North Mississippi.

The overturn rate, or the percentage of claims ultimately approved by the insurance company, has remained at about 85% since last year.

"We continued conversations about the core problem, which has been the denial percentage itself, but we never really received a clearly defined response from United as to why those denials were occurring," Davis said.

United Healthcare proposed a range of options and solutions aimed at keeping the health system in its Medicare Advantage network, including extending the existing contract to continue negotiations, said Tracy Carr, a spokesperson for the company.

"Unfortunately, NMHS refused," Carr said. "Our priority now is providing the people we serve with the care they need, either through continuity of care or by helping them transition to another provider, as appropriate."

Patients with United Healthcare Group Retiree Medicare Advantage plans will be able to continue receiving services at North Mississippi Health Services locations because these plans offer out-of-network benefits. Patients' share of the cost will be the same as if they were part of the network for some or all services, said Carr.

Medicare is the federal health insurance program for people 65 and older and with certain disabilities. Medicare Advantage is a type of Medicare plan run by private insurance companies that contract with the government. The plans often offer additional benefits, including dental, vision and prescription drug coverage, that aren't included in traditional Medicare plans.

In Mississippi, 44% of Medicare recipients are covered by Medicare Advantage plans.

United Healthcare members who are in the middle of treatment with a North Mississippi Health Services provider for a serious or complex condition may be eligible to continue receiving covered services for a period of time, Carr said.

Davis encourages patients to contact Medicare to discuss options for changing their Medicare Advantage enrollment, including utilizing a special enrollment period.

Medicare's open enrollment period occurs from Oct. 15 to Dec. 7. There is an additional open enrollment period for people who are already enrolled in Medicare Advantage Plans from Jan. 1 to March 31.

-- Article credit to Gwen Dilworth for Mississippi Today