North Mississippi Health Services (NMHS) has ended its contract with United Healthcare for certain Medicare Advantage plans. The change took effect on June 1. The decision comes after more than a year of talks between NMHS and United Healthcare.
NMHS operates eight hospitals and over 70 clinics in North Mississippi. United Healthcare is the nation’s most profitable health insurance company. About 17,000 United Healthcare Medicare Advantage members live in NMHS’s service area.
Most of them are existing patients, said Wally Davis, NMHS’s vice president of payor strategy and partnerships. Other United Healthcare plans will still be in-network at NMHS. These include commercial and employer-sponsored, Marketplace, Medicaid, and CHIP plans.
The change will also apply to Medicaid-required Dual Special Needs Medicare Advantage plans. NMHS ended the agreement because Medicare Advantage inpatient claims were often delayed or denied, Davis said. The issue has gotten worse since NMHS first raised concerns last year.
In May, 42% of inpatient claims at North Mississippi Medical Center-Tupelo were initially denied. This is up from 17% in February 2024.
nmhs drops United Healthcare Medicare Advantage
The overturn rate has stayed around 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 suggested extending the current contract to keep talking, said Tracy Carr, a spokesperson for the company.
“Unfortunately, NMHS refused,” Carr said. Patients with United Healthcare Group Retiree Medicare Advantage plans will still be able to get services at NMHS locations. 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, according to Carr. United Healthcare members who are in the middle of treatment with an NMHS provider for a serious or complex condition may be able to keep getting covered services for a period of time, Carr said. Davis encourages patients to contact Medicare to discuss options for changing their Medicare Advantage enrollment.
This includes during the special enrollment period. Medicare’s open enrollment period is from Oct. 15 to Dec.
7. There is an additional open enrollment period for those already enrolled in Medicare Advantage Plans from Jan. 1 to March 31.