UnitedHealthcare - Community Update
Sarasota Memorial’s highest priority is ensuring our community has access to top-quality, comprehensive, affordable medical care. Negotiating fair contracts with insurance companies, such as UnitedHealthcare, every few years is standard practice for medical providers, and essential to providing high-quality services in the future.
While rates and reimbursement terms are a normal part of updating insurance contracts, there are more serious flaws that must be addressed with Medicare Advantage plans, evidenced by the increased scrutiny from policymakers and Centers for Medicare and Medicaid Services working to address the plans’ restrictive prior authorization and coverage issues.
Sarasota Memorial and First Physicians Group have experienced these challenges with United’s Medicare Advantage plans, including inappropriate denials that restrict access and essential care. We are asking United to address these issues with provisions that better protect patients from inappropriate claim/coverage denials and the integrity of the physician-patient relationship. While negotiations have not stalled, United has been slow to respond to our requests and contract proposals. We continue to work in good faith and as quickly as possible to reach a new Medicare Advantage agreement with United and hope to resolve our issues before our current agreement expires at the end of this year. In the event we cannot reach agreement by Dec. 31, 2023, our 2 hospitals, outpatient and urgent care centers and First Physicians Group practices will become out-of-network for UnitedHealthcare Medicare Advantage plans, including their AARP Medicare Advantage and Dual Special Needs plans (D-SNP) plans, on Jan 1, 2024.
We realize this situation can be a source of great anxiety for people enrolled in United’s Medicare Advantage plans. Please scroll down for Frequently Asked Questions and check back for future updates. We also encourage you to contact UnitedHealthcare to convey your concerns. Working together, it is our sincere hope to reach a new agreement before this situation impacts members in our community.
Important Alert for People with Medicare Advantage Plans
Although the annual enrollment period for most people eligible for Medicare ends Dec. 7, Medicare Advantage plan-holders have one more chance to make limited changes during the Medicare Advantage Open Enrollment which runs from January 1 – March 31. You can use this enrollment period only if you are already enrolled in a Medicare Advantage plan. Plan holders can switch to a new Medicare Advantage plan or drop their Medicare Advantage plan and return to original Medicare once during this period. Coverage starts the first day of the month after you apply to join a plan. Visit Medicare.gov for more details.
Please note that all Sarasota Memorial facilities and First Physician Group practices always accept original Medicare and all standard Medicare/Medigap supplemental plans.
If you prefer a Medicare Advantage plan, click here for a up-to-date list of Medicare Advantage Plans that will be in-network with Sarasota Memorial as of January 1, 2024. Click here to obtain updated information on Medicare Advantage health insurance companies contracted with First Physicians Group.
Need help deciding on a plan? You can call or meet one-on-one with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased, and confidential. Call the Florida Elder Helpline at 1-800-963-5337, or visit www.floridashine.org.
Frequently Asked Questions
As negotiations continue, we know that UnitedHealthcare Medicare Advantage plan members will have concerns. Below are answers to frequently asked questions.
Is Sarasota Memorial trying to reach an agreement with UnitedHealthcare? Could this be resolved in the coming days?
SMH and First Physicians Group have been engaged in good-faith negotiations with UnitedHealthcare for several months, and we hope to come to an agreement before the year end. It is normal business practice for hospitals and health insurers to renegotiate and renew insurance contracts every few years, in order to reflect new regulations, changes in reimbursement, increases in healthcare costs, and advances in technology and care.
Such agreements have become increasingly complex, not just here but across the nation, due to restrictive prior authorization and coverage issues that providers, regulators and policymakers are working to address with many Medicare Advantage plans. While we are not certain that we will be able to reach an agreement before our current agreement expires, we want to assure you that we remain in active discussions with UnitedHealthcare, and that reaching a new agreement before it impacts our community and our patients is our highest priority.
Which SMH/FPG services are affected?
If a new contract is not in place by Jan. 1, 2024, Sarasota Memorial Hospital-Sarasota, Sarasota Memorial Hospital-Venice, and SMH’s complete network of outpatient and urgent care centers and First Physician Group (FPG) practices will be out of network for all of UnitedHealthcare’s Medicare Advantage plans, including their AARP Medicare Advantage plan and Dual Special Needs plans (D-SNP).
Will UnitedHealthcare plan members still be able to access Behavioral Health Services?
Yes, behavioral health services are covered under a separate UnitedHealthcare plan. SMH will continue to remain in-network with UnitedHealthcare for behavioral health services, even if our other agreements expire at the end of this year.
What if I have traditional Medicare or Medicare (Medigap) supplemental plans?
Patients with original Medicare and standard Medicare (Medigap) supplemental plans will not be impacted. Sarasota Memorial and FPG always accept traditional Medicare and all standard Medicare (Medigap) supplemental plans.
Do I need to reschedule my procedure or appointment scheduled for after Jan 1?
At this time, we are not advising patients to reschedule any appointments that are currently scheduled for after Jan 1, 2024.
What would happen in emergency situations if Sarasota Memorial is no longer in-network with United?
In emergency situations, you should always go to the nearest ER – no authorization is needed, and a patient’s financial responsibility is usually no higher if they go to an out-of-network hospital or freestanding ER for emergency care.
What if I’m pregnant? Or need continuing care for an illness or injury?
There are provisions in state law to ensure continuing care at in-network rates for women who are pregnant and for patients in the midst of treatment for certain medical conditions, such as cancer. Although there are limitations, Sarasota Memorial will work with patients affected in these circumstances to ensure they receive the care they need. We encourage you to call UnitedHealthcare to discuss your specific situation.
What will this mean for my relationship with my FPG doctor?
If SMH and UnitedHealthcare cannot reach agreement by Dec. 31, 2023, Sarasota Memorial’s First Physicians Group also will become “out-of-network” with United’s Medicare Advantage plans on Jan. 1, 2024. We will do everything we can to ensure continuity of care for our pregnant mothers and other patients who may qualify for continued treatment.
Where can I get help with Medicare enrollment?
You can learn about your Medicare plan options by calling or meeting with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased, and confidential. Call the Florida Elder Helpline at 1-800-963-5337, or visit www.floridashine.org.
The Medicare website also contains key enrollment dates and other important information:www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
Is There Anything I Can Do?
If having Sarasota Memorial and FPG as in-network providers is important to you, we encourage you to consider switching to original Medicare and a standard Medicare (Medigap) supplemental policy if possible. SMH and FPG always accept original Medicare and all standard supplement plans.
Information about which Medicare Advantage plans SMH and FPG will accept as of Jan. 1, 2024 is on our website at www.smh.com/medicare and www.firstphysiciansgroup.com/insurance.
If your options are limited to UnitedHealthcare’s Medicare Advantage plans, we encourage you to call the number on the back on the back of your insurance card and talk to UnitedHealthcare and/or your human resources/retiree health benefits manager to express your concerns. Let them know how you and your family members are being affected, and why it is important that Sarasota Memorial and FPG remain part of your covered network.
Sarasota Memorial Billing Advocacy Office: If you have questions about how this might impact your ability to seek care at Sarasota Memorial Hospital or our outpatient and urgent care centers, please call SMH’s Billing Advocacy Office at (941) 917-1540 or (800) 764-2455, weekdays from 8 a.m. to 5 p.m.
First Physicians Group: If you have questions about how this might impact care provided by your FPG physician, please contact FPG’s central office at (941) 917-2600, weekdays from 8:30 a.m. to 5 p.m.