‘Worst nightmare.’ Medicare patients on alert as deadline nears for UHealth, United

Charlotte Libov, a medical writer in Miami Beach, has always encouraged cancer patients to undergo treatment, if they can, at federally designated comprehensive cancer centers whose doctors are leaders in research and clinical trials and usually offer the latest treatments.

Now, Libov, who is in the midst of her own breast cancer battle, might not be able to follow her own advice. An ongoing contract dispute between the University of Miami Health System and UnitedHealthcare involving reimbursement rates could bar Libov and many other patients from accessing in-network care at Sylvester Comprehensive Cancer Center, South Florida’s only National Cancer Institute-designated cancer center.

“I’m feeling kind of trapped,” said Libov, who has written about cancer for over 25 years. Libov, 76, hasn’t slept well since finding out her doctors are at risk of leaving United’s network. “This is kind of my worst nightmare.”

UHealth is accusing UnitedHealthcare, the largest health insurer in the nation, of refusing to pay doctors enough for care. United is accusing the health system of wanting too much money.

If a deal is not made soon, UHealth doctors and facilities will go out-of-network as early as Aug. 1 for thousands of people across South Florida who have a commercial, ACA Marketplace or Medicaid plan through United.

For people like Libov who have a Medicare Advantage plan through the United-owned Preferred Care Network, UHealth doctors and its facilities will go out-of-network as early as Sept. 1 if a deal isn’t made. UHealth told the Herald it’s “trying to negotiate” with United to extend coverage until the end of the year for over 26,000 of its patients who are enrolled in a PCN Medicare Advantage plan.

If a deal isn’t made by deadline day, the health system’s wide range of primary and specialty care experts will no longer be in-network for United and Preferred Care Network members, including at Sylvester and Bascom Palmer Eye Institute, the top eye hospital in the country.

And because of the unique partnership UM’s health system and medical school have with Miami-Dade’s public health system, United and Preferred Care Network members may not be able to seek care with UHealth doctors who work on the campus of Jackson Memorial Hospital in Miami, including at the Miami Transplant Institute, Christine E. Lynn Rehabilitation Center and Holtz Children’s Hospital.

“The vast majority of doctors who care for patients at Jackson Memorial Hospital are UHealth doctors. If UHealth is forced out of UnitedHealthcare’s network, UnitedHealthcare members who see those doctors at Jackson may have to pay more or lose all access, depending on their health plan,” UHealth said in an email to the Miami Herald last week. “Jackson Memorial Hospital cares for many of South Florida’s most vulnerable communities. Losing access to UHealth doctors would mean many could have to travel farther, miss work, or pay more to see a doctor.”

Jackson Health has its own contract with United, so its hospitals, ER and outpatient centers would still be in-network for United members, even if UHealth were to go out-of-network, the public health system told the Herald. That means United members would likely need to seek care with a Jackson doctor, not a UHealth doctor, to get in-network care if a deal isn’t made.

“We understand that changes related to payer contracts can create uncertainty for patients, and Jackson Health System remains focused on supporting our patients and helping ensure they have access to the care they need,” Jackson told the Herald in a Tuesday statement, noting the “important role UHealth physicians play in caring for patients.”

“With another week of active negotiations underway, we remain hopeful that UHealth and UnitedHealthcare will reach an agreement that serves the best interests of the South Florida community,” Jackson said. The health system is encouraging patients to contact their doctors and insurer with any care coverage questions.

What wouldn’t be affected if UHealth were to go out-of-network: the Jackson-UHealth urgent care centers across Miami-Dade County, which are staffed by Jackson Health doctors, according to UHealth. All UHealth services are also expected to remain in-network for UM students enrolled in the university’s United Student Health Insurance Plan, according to The Miami Hurricane, the private university’s student newspaper.

“Our goal is to renew our relationship and we remain engaged in good-faith discussions with UHealth,” United recently told the Herald in an email.

The news that UM students will remain in-network gives Libov some hope that a deal will be made between UHealth and United. Still, she’s worried. Libov said she’s receiving treatment through a clinical trial at Sylvester, which means it’s not a standard treatment she can get at other South Florida hospitals.

When she called United, Libov said she was reassured she would be able to continue getting treatment at Sylvester until January through “continuity of care,” a temporary permission health insurers can give certain patients, such as those undergoing active cancer treatment, to continue receiving in-network care for a certain period of time with an out-of-network provider. She’s hoping to get that in writing and is already planning to research other Advantage plans to see which ones will cover her doctors at Sylvester and Mount Sinai Medical Center, the nearest hospital to home, in case she has to change insurances for 2027.

The stress, she said, is a tough reminder of the risks seniors face when they choose an Advantage plan, an option that has become increasingly popular through the years, over traditional Medicare in an industry that is “like a moving target.”

Medicare Advantage plans often provide members with additional benefits beyond medical care, including dental and vision, and usually have an annual cap on out-of-pocket expenses. But patients are required to get care with in-network doctors, a list that can change as providers are added and removed.

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Hospitals and health insurers undergo negotiations all the time, and sometimes, an agreement is not reached until the final hour. Often, negotiations happen behind closed doors. Memorial Healthcare System, one of the public health systems in Broward County, for example, recently renewed a new two-year agreement with CVS Health-owned Aetna, securing continuous in-network care for the insurer’s members.

Other times, negotiations get complicated and spill out into the public, like the dispute between UHealth and United. Patients receive letters warning them that their in-network care could end soon. Webpages are created by both the health system and the insurer to answer common questions from patients, such as how to request an in-network extension for cancer treatment and other critical care — and, often, to point the finger at the other party as the reason a deal has not been made yet.

For 83-year-old patient Frank Sioli, the news that UHealth could suddenly go out-of-network was “just another roadblock to try to negotiate through the health insurance system.”

“We spend billions of dollars telling people ‘no’ when we could be using these dollars to cover benefits,” said Sioli, who was diagnosed with Non-Hodgkin’s lymphoma in January.

Sioli was recently declared cancer-free, though he still needs to visit his doctors at UHealth for monitoring. He said United quickly approved his “continuity of care” request, which will cover his doctor visits through at least the end of 2026. If his doctor were to order more treatment, Sioli would need to make another “continuity of care” request with the health insurer.

Still, the South Miami-Dade resident and longtime Sylvester supporter has already made a gameplan ahead of January’s open enrollment, when people already enrolled in Medicare Advantage plans can switch to other Advantage plans. He’s made a list of the doctors and facilities he wants to keep in-network and plans to review other available Advantage plans to see which ones match his list, just in case UHealth does end up out-of-network.

“You have to have a plan, or as Yogi [Berra] would say, if you don’t know where you’re going, you might not get there,” said Sioli.

The U.S. Centers for Medicare and Medicaid Services requires Advantage plans to notify members 45 days before a primary care doctor they recently visited leaves their plan and 30 days before a specialist drops out, according to KFF, a nonprofit that specializes in health policy analysis and other health information.

But hospitals and insurers often share news of ongoing, or stalled, negotiations as a pressure tactic, urging patients or members to call the other party and push to finalize a new contract.

The situation has frustrated Weston City Commissioner Byron L. Jaffe, who said he’s contacted UHealth and has emailed the CEO of United’s Florida division, urging the insurer not to kick UHealth’s academic health system out-of-network. Jaffe, a retired American Airlines captain, is no longer insured with United but has heard from many worried residents, family and friends, including former American Airlines colleagues. United is the health insurer for American Airlines, the largest for-profit employer in Miami-Dade County.

“The last two times I’ve been involved in this, one got settled, the other didn’t,” said Jaffe, referencing a similar dispute between Cleveland Clinic Weston and United that was eventually resolved a few years ago and the ongoing fallout between Broward’s public health systems and Florida Blue, the largest insurer in the state.

Just like UHealth with United, Broward Health and Memorial Healthcare System have accused Florida Blue of not paying it enough for care. Florida Blue, similar to United, argues that the hospitals want too much money. No deal has been made yet, leaving thousands of Florida Blue members unable to receive in-network care across Broward Health and Memorial, including at the Memorial Transplant Institute and at Joe DiMiaggio Children’s Hospital, one of the top pediatric hospitals in the country.

“I’m not a betting man, but this means it’s a 50-50 odd if it gets settled or not,” said Jaffe, expressing his discontent with those odds as the deadline creeps closer. He said the Florida Blue fallout with Memorial and Broward Health, for example, has led to more patients, and longer wait times, in Cleveland Clinic’s Weston ER.

Both UHealth and United say that their own negotiations are still ongoing. But the clock is ticking.

And for Florida seniors who may be thinking that the solution is to just switch in October during open enrollment to traditional Medicare, it might not be that easy, according to AARP. If you didn’t buy a Medigap plan when you initially enrolled in an Advantage plan, the moment you try to switch to original Medicare, “insurers can reject you because of preexisting conditions, charge you more and delay your coverage after you’re accepted.”

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