- Contract negotiations between Sarasota Memorial Hospital and UnitedHealthcare have stalled, risking the in-network status of Sarasota Memorial’s facilities for UnitedHealthcare’s Medicare Advantage plan members.
- The current contract is due to expire on December 31, 2023.
- Sarasota Memorial cites lower reimbursement rates and frequent coverage denials in Medicare Advantage programs as key issues in the negotiations.
- If no agreement is reached by the year-end deadline, Sarasota Memorial’s hospitals, outpatient and urgent care centers, and First Physicians Group practices will become out-of-network for UnitedHealthcare Medicare Advantage plan members.
Negotiations between Sarasota Memorial Hospital and UnitedHealthcare for contract renewal have broken down, potentially affecting thousands of patients enrolled in UnitedHealthcare’s Medicare Advantage plans.
Per a public notice page uploaded by the hospital, Sarasota Memorial has been engaged in discussions with UnitedHealthcare since August, though it claims talks have been complicated by issues with Medicare Advantage programs, including lower reimbursement rates and frequent denials of coverage compared to traditional Medicare. The current contract between the two entities is set to expire on December 31, 2023.
Should the parties fail to reach an agreement by the year-end deadline, Sarasota Memorial’s facilities of practice will become out-of-network providers for UnitedHealthcare Medicare Advantage members starting January 1, 2024.
“We continue to engage in active discussions, but in the event we cannot reach agreement with UnitedHealthcare by year-end, our 2 hospitals, outpatient and urgent care centers and First Physicians Group practices will become out-of-network providers for United Medicare Advantage plans as of Jan 1, 2024,” the hospital network stated on its site.
Sarasota Memorial also contended that the process of renewing contracts has been broadly complicated by issues related to Medicare Advantage programs both locally and nationwide. the healthcare provider claimed that many health systems have opted out of contracts with such plans because they offer “lower reimbursements compared to traditional Medicare” and “frequently deny coverage or restrict essential care.”
“This year, contract renewals have become more complex due to challenges patients and their care providers are experiencing locally and around the nation with certain Medicare Advantage programs,” wrote Sarasota Memorial. “Recently, a number of health systems have chosen to end their contracts with Medicare Advantage plans because they reimburse far less than traditional Medicare and routinely deny coverage and limit necessary care.”
Upon outreach to UnitedHealthCare, a representative told The Capitolist that the company is working to reach a deal with Sarasota Memorial.
“Our goal is to renew our relationship with Sarasota Memorial Healthcare System and ensure the people we serve have continued, uninterrupted access to the health system,” the company said over email.