If you are a member of United Health Care and a patient of the University of Florida Health (UF Health), a recent development may affect your ability to seek care with your normal provider. United Health Care has excluded UF Health from its provider network as of September 1, 2024.
Depending on your health insurance plan through the organization, United Health Care may no longer cover your services at UF Health. This could mean you need to find a different healthcare network covered by United Health Care or pay out of pocket for services through UF.
This change is due to a contract dispute between United Health Care and UF Health. The two parties may resolve this dispute in time, but for now, you should understand the potential changes to your healthcare and how to proceed.
UF Health’s History With United Health Care and What Led to This Decision
United Health Care has had a network relationship with UF Health for many years, though contract and price disagreements have led to several challenges throughout the parties’ relationship. At the time of the contract expiration in September 2024, United Health Care offered in-network coverage for UF Health providers to those enrolled in its:
- Employer-sponsored commercial plans
- Medicaid plans
- UF Student Health Insurance Plan through Student Resources
On October 1, 2021, United Health Care established a new network relationship with UF Health for its Medicare Advantage plan members. This multi-year agreement opened the doors to UF Health’s services for countless more members.
Early in 2024, contract disputes arose between the two organizations. UF Health cited the need for rate increases for its physicians to keep up with rising labor and supply costs. Negotiations ensued leading up to the contract expiration on September 1.
According to a statement from United Health Care, UF Health sent a proposal on August 29 detailing its demands for a 30% rate increase over two years, which included a 20% increase during the first year. United Health Care delivered a counteroffer on August 30, which UF Health failed to respond to.
Exploring the Typical Dynamics Between Insurance Providers and Healthcare Institutions
Healthcare institutions and insurance providers strive to create a contract that is mutually beneficial for both parties. Insurance providers foster member satisfaction when they cover services from trusted healthcare providers and networks like UF Health. Meanwhile, healthcare institutions gain more patients when they offer in-network services for major insurance providers, like United Health Care.
Insurance providers negotiate fee schedules with providers to determine how much providers will be paid for each service. These fee schedules can fluctuate depending on the provider, payor, state, and region. For example, fees for commercial insurance members are usually higher than those for Medicare members.
Because a healthcare institution’s fees are highly variable, negotiations for higher fee schedules often ensue between health networks and insurance providers. In this case, UF Health attempted to negotiate a rate increase, and United Health Care could not meet its demands, leading to the contract expiration.
Overview of United Health Care’s Exclusion of UF Health
United Health Care’s exclusion of UF Health went into effect on September 1, 2024. As a result of the contract expiration, UF Health is now out of network for the following UnitedHealthcare plans, disrupting care for approximately 30,000 people:
- Medicaid coverage plans
- The UF Student Health Insurance Plan through Student Resources
- Employer-sponsored commercial plans, including UMR
UF Health Central Florida and UF Health’s psychiatric hospital are part of a separate contract and remain in-network.
This change does not affect United Health Care’s Medicare Advantage or Dual Special Needs Plans at other UF Health hospitals and provider locations.
Both parties have released statements about this change. “We know many people value having access to UF Health’s providers and are rightfully concerned an agreement has yet to be reached,” says United Health Care in its statement. “We need UF Health to join us at the negotiating table and to work toward solutions that are sustainable for Florida families and employers.”
Marvin Dewar, M.D., J.D., chief executive officer of UF Health Physicians, expressed a similar sentiment: “We are committed to doing our part to reach an agreement that would prevent disruption to all our patients’ continued access to UF Health physicians and facilities for non-emergency services and care… We are continuing to negotiate in good faith, but we are waiting for the health plan to respond with a fair and sustainable offer to make that happen.”
What Does This Exclusion Mean for United Health Care Members and UF Health Patients?
United Health Care members under any of the now-excluded plans may be treated as out-of-network if they choose to continue services at UF Health. UF Health has made arrangements to continue to care for certain patient groups and make this transition as seamless as possible for its patient base.
Patients with urgent care needs can speak to their provider about continuing care at UF Health. This includes:
- Pregnancies
- Nonelective surgeries
- Cancer care
- Emergency medicine
- Behavioral health
- Transplants
UF students with United Health Care plans through the student health insurance program can continue receiving care at the UF Student Health Care Center and all other UF Health facilities. Students who have United Health Care coverage through a parent’s insurance can also continue receiving care at the Student Health Care Center but not any other UF Health facilities.
According to United Health Care, meeting UF Health’s demands for a 30% rate increase would place a significant financial burden on certain members, such as:
- Self-insured employers: Nearly 20 self-funded businesses would see their healthcare costs increase by up to $200,000 per year
- Consumers: The cost of a C-section would increase by more than $1,500 at Shands Jacksonville and $1,000 at Shands Gainesville, for example
Knowing this side of the equation could help United Health Care members understand the provider’s refusal to accept UF Health’s rate increase demands.
Patients and the Medical Community Respond
Marvin Dewar, chief executive officer of UF Health Physicians, maintains the necessity of this network exclusion under United Health Care’s refusal to meet its demand, saying, “As a physician, my job is to care for my patients, and we did our best to avoid this situation.”
“As the state’s leading academic health system that researches leading-edge treatments, educates future generations of clinicians, and treats a disproportionate number of underserved patients, we deserve to be paid fairly and competitively for the care we provide to patients and the services we offer,” Dewar continued. “Reasonable compensation is necessary for us to sustain our mission.”
United Health Care’s exclusion of UF Health has sparked turmoil among patients. One United Health Care member wrote in an online forum: “I am so furious I can’t breathe.” Patients are scrambling to find out whether they are still covered for UF Health services and what the future of their care at this facility may look like.
Unfortunately, UF Health is not the only healthcare provider at a negotiation impasse with United Health Care. Duke University Health System is also in negotiations over a November 2024 contract expiration. One patient expressed concerns over paying for surgery without in-network coverage: “I [have to] get the operation. It’s a matter of walking and being comfortable. I have no choice.”
Will This Exclusion Be Permanent? Potential Resolutions and Future Outlook
UF Health and United Health Care have indicated they are willing to continue negotiating. As of November 13, 2024, United Health Care reports that “little progress has been made.” According to the insurance provider, UF Health took 70 days to counter its last proposal, and the new proposal moved backward in some areas.
Patients can hope that their UF Health services will eventually be covered under United Health Care again. However, this contract dispute may set a precedent for future negotiation problems between insurers and healthcare providers. When the two parties fail to reach an agreement about reimbursement rates, it seriously disrupts members’ care.
Ongoing trends in this direction could lead more patients to stray from traditional health insurance options in favor of ones that do not limit coverage to specific providers. For now, contract expirations spell a disruption in the continuity of and access to care, which poses serious risks for patients and could leave healthcare providers liable for errors.
Synergy Medical Group Meets Patients Where They Are
While United Health Care’s exclusion of UF Health from its provider network has sparked confusion for many, ongoing negotiations could allow the two parties to reach an agreement in time. If you are a member of United Health Care and a patient of UF Health, stay informed about these changes and how they may affect your healthcare options.
Synergy Medical Group offers comprehensive patient care through a team of exceptional medical providers. We bring care right to the bedside, regardless of location or facility. We also have a family practice and multi-specialty clinic located in Gainesville, Florida. Contact us today at 352-234-3050 to learn about our coverage under United Health Care and our patient services.
You can learn more about United Health Care’s exclusion of UF Health by reviewing the statements released by both parties:
UF Health invites patients with questions to call 1-855-834-7337 or 352-265-8585 or review a set of frequently asked questions here.
United Health Care members can call the number on their membership identification cards to speak with a representative or refer to these customer service numbers:
- Commercial: 1-866-801-4409
- Medicaid Managed Care: 1-888-716-8787
- Medicare Advantage: 1-855-893-5505
United Health Care also has a list of FAQs here.
