Essentia To Stop Accepting Insurance From 2 Providers In MN, WI

Sometimes a company makes a difficult decision that has an impact on a lot of people and when that happens, the hope is that while there will be a difficult transition period, it will be best for everyone in the long run.

That scenario is what Essentia Health is hoping plays out with a major decision they've made regarding Medicare Advantage plans they work with as in-network providers. This change will impact patients in Minnesota, Wisconsin, and North Dakota.

While they've begun to notify patients impacted by the decision, on September 10 they announced it to the general public and explained why they deemed the change necessary.

Essentia Will Stop Serving As An In-Network Provider For 2 Medicare Advantage Plans

Essentia Health announced that it has started the process of informing patients that, due to excessive prior authorization requirements and denial of care, they no longer will serve as an in-network provider for Medicare Advantage plans administered by UnitedHealthcare (UHC) and Humana. This change will be effective beginning Wednesday, January 1, 2025.

According to Essentia, UHC and Humana delay and deny care approval for their patients at more than twice the rate of other Medicare Advantage plans. These denials and delays can cause unnecessary hardships for many Essentia patients.

Dr. Cathy Cantor, Essentia’s chief medical officer for population health, says that they have been re-evaluating their participation in Medicare Advantage plans that added strain on their patients by "too often denying or delaying their care."

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Dr. Cantor added that while this decision was not made lightly, "the frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve."

Options For Patients Currently Using These 2 Medicare Advantage Plans

Those with a UHC or Humana Medicare Advantage plan can choose an alternative option during Medicare open enrollment, which goes from October 15 through December 7.

Essentia Health encourages patients to verify that any new plan is in-network with Essentia to prevent gaps in care. Alternative in-network Medicare plan options include Medica, UCare, EssentiaCare, Blue Cross Blue Shield of Minnesota and North Dakota, HealthPartners, Security Health, traditional Medicare, and Medicare supplemental plans.

As noted above, Essentia is notifying all patients affected by this change and will work with them to ensure continuity of care.

Any patients with questions are encouraged to speak with an Essentia representative by calling (800) 985-4675 between 8 a.m. and 5 p.m. Monday through Thursday or 9 a.m. and 4:30 p.m. on Fridays.

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Furthermore, patients can learn more about this situation and become familiar with Medicare plans available through Essentia at one of the following web pages:

• UHC patients: Essentiahealth.org/UnitedHealthcare
• Humana patients: Essentiahealth.org/Humana