North Mississippi Health Services has terminated its agreements with UnitedHealthcare Medicare Advantage plans, which took effect on June 1. This means that NMHS facilities and providers are now out-of-network for patients with these insurance plans. The decision affects approximately 17,000 UnitedHealthcare Medicare Advantage members who reside in NMHS’s 24-county service area.
Most of these individuals are existing patients of the health system. Wally Davis, NMHS Vice President of Payor Strategy and Partnerships, said the agreements ended because patients with these plans were experiencing delayed or denied care. In May, 42% of inpatient claims at North Mississippi Medical Center-Tupelo were initially rejected, up from 17% in February 2024.
Despite following the appeals process and achieving an overturn rate of up to 85%, NMHS never received a clear answer from UHC on why the denials were happening. Negotiations between the two organizations had been ongoing for over a year.
Termination of Medicare Advantage agreements
Other United Healthcare plans, including commercial, employer-sponsored, Marketplace, Medicaid, and CHIP plans, will continue to be in-network with NMHS. Patients with UHC Group Retiree Medicare Advantage plans will also be able to continue receiving services because these plans offer out-of-network benefits. UHC spokesperson Tracy Carr said the company had proposed various options to keep NMHS in its Medicare Advantage network, but the health system refused.
UHC’s priority now is to provide continuity of care for patients or help them transition to another provider. Medicare beneficiaries can make coverage changes during the Annual Enrollment Period each fall and the Open Enrollment Period, which ended March 31. Davis encourages affected members to call Medicare and ask about their Special Enrollment Period rights.
Patients are advised to verify their benefits and eligibility by calling the customer service number on their insurance card. Individuals being treated for multiple conditions must submit separate requests for each condition.