Medicare negotiations between Sarasota Memorial and UnitedHealthcare go down to the wire

Sarasota Memorial Hospital patients who currently use UnitedHealthcare Medicare Advantage plans will still have options to remain in network for care, should the current contract between the two expire on Dec. 31.

The national open enrollment deadline is Dec. 7, though people enrolled in all Medicare Advantage plans can change their mind and hop to a different provider during the General Enrollment Period that runs Jan. 1-March 31, 2024.

Negotiations between Sarasota Memorial Health Care System and UnitedHealthcare cover only the Medicare Advantage plans and involve both payment for services at the two Sarasota Memorial hospitals and those rendered by medical professionals affiliated with First Physicians Group.

Letters sent  to roughly 20,000 people enrolled with UnitedHealthcare Medicare Advantage plans, full-page newspaper ads by SMH and a recent article in the Herald-Tribune have sparked unease among many of those people, said Michelle Litzer, a Nokomis-based insurance agent specializing in UnitedHealthcare policies.

“This is the nature of insurance companies and people are frightened,” said Litzer, who has fielded many calls from her clients. “The way enrollment periods go, there’s a lot of language misuse.”

She considered the March 31 deadline for Medicare Advantage enrollees to swap plans as the real deadline.

“In my opinion the fear tactic is you only have until Dec. 7,” Litzer said. “It may be a tactic the suits are using to say ‘Let's get this show on the road.

“It’s a horrible game, it’s not fair to the seniors at all,” she added.

What is the Jan. 1-March 31 General Enrollment Period?

This window – in effect nationally – gives people enrolled in Medicare Advantage a chance to switch plans once.

There is a possibility that Sarasota Memorial and UnitedHealthcare may choose to extend their existing contract beyond the Dec. 31, 2023 expiration date.

Should both sides fail to come to terms, this time period would allow an opportunity for people to choose another Medicare Advantage provider to remain in-network at SMH.

However, if an enrollee chooses to change plans in, say, January 2024, that coverage would not go into effect until February.

It would also be possible to choose traditional Medicare, pick a Part D drug plan and a Part B supplement, too.

UnitedHealthcare is the only Medicare provider currently negotiating a contract with SMH.

SMH lists its network status for Medicare Advantage providers at: https://www.smh.com/Medicare.

It is also updating status of its negotiations with UnitedHealthcare at https://www.smh.com/unitedhealthcare.

For an impartial guide to signing up for Medicare, the hospital suggests contacting SHINE – Serving Health Insurance Needs of Elders – a free program offered by the Florida Department of Elder Affairs and the local Area Agency on Aging at 1-800-963-5337 or https://www.floridashine.org.

It is possible to set  up an in-person chat with a local SHINE volunteer.

Where are negotiations now?

Both sides are still talking. In response to an email query SMH Spokeswoman Kim Savage wrote: “We continue to work in good faith and as quickly as possible to reach a new Medicare Advantage agreement with UnitedHealthcare. But it has been some time since we submitted our last contract proposal, and despite the urgency this agreement warrants, the insurer has yet to submit a counter offer."

A UnitedHealthcare spokesperson did not respond to an email for comment on the status of the talks by deadline.

“While negotiations have not stalled, United has been slow to respond to our requests and contract proposals,” Savage continued.

“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,” she added.

Savage went on to cite that both SMH and First Physicians Group have experienced several challenges with United Healthcare’s Medicare Advantage plans, including inappropriate denials that restrict access to essential care.

“We are asking United to address these issues with provisions that better protect patients and the integrity of the physician-patient relationship,” Savage wrote. “We also encourage them to call the number on the back of their insurance card and let the insurer know how this situation affects them and how important it is to continue to have in-network access to SMH and their FPG providers.”

What about the Idalia Special Enrollment Period?

After Hurricane Idalia, Gov. Ron DeSantis created a Special Enrollment Period for people impacted by Hurricane Idalia, who may not have been able to enroll in Medicare or change plans during the existing national enrollment periods.

That period started Aug. 26 and technically runs through Feb. 29, 2024, and Charlotte, Manatee and Sarasota counties are among those counties that are impacted.

However, that special enrollment period is not a license for just anyone to apply outside the federal deadlines, as Medicare could choose to audit the application to see whether an individual was impacted by the disaster.

This article originally appeared on Sarasota Herald-Tribune: What happens if Sarasota Memorial and UnitedHealthcare don't agree?