FORT MYERS, Fla. (WINK) — Patients across Southwest Florida are facing a shrinking list of medical options as Lee Health’s ongoing contract dispute with UnitedHealthcare highlights the vast influence of regional hospital monopolies.
As the largest employer and dominant healthcare provider in Lee County, Lee Health operates a single, sprawling hospital network that leaves tens of thousands of residents with few alternatives if the system drops their insurance coverage.
Starting next year, affected UnitedHealthcare policyholders face the possibility of Lee Health hospitals and physicians being completely out of network, leaving many trapped between high out-of-pocket costs and switching doctors.
“The biggest health conglomerate in this county named for this county is going to exclude however many of this county live here,” said Angela Bayless, a Lee Health patient.
For others who rely on Lee Health and use Unitedhealthcare, like Michele Perez, the impasse presents an unfair ultimatum: “What choice do I have, [spend more] money or new doctors? Go to the drawing board and figure something out to help us because you’re not helping us—you’re making the problem worse for us.”
A Regional Geographical Monopoly
The concentration of care in Southwest Florida amplifies the stakes of contract fallouts. Unlike major metropolitan regions with competing health systems, Lee Health’s single-system domination creates a unique geographical barrier for patients seeking in-network treatment.
Camilita Aldridge, Director of Programs and Planning for SHINE (Serving Health Insurance Needs of Elders), noted that in her 12 years on the job, the sheer geographic impact of this dispute is unprecedented.
“The hospital system here, it’s a single hospital system,” Aldridge said. “That creates a new challenge we haven’t seen before. It’s not just affecting folks in Lee who are enrolled in the United plans, but some surrounding counties as well, like portions of Collier, Hendry, Glades, and DeSoto.”
While patients with traditional Medicare Supplement plans remain protected, those enrolled in Medicare Advantage or employer-based plans face driving long distances or abandoning their providers.
“You can go to Naples, or you can go to Lehigh. They have a hospital there,” said patient Kay Halloway. “I don’t want to drive to Naples. I want to be close to my home. I go to the hospital right up here.”
Financial Standoff and Accusations
Lee Health officials maintain that the decision to cut ties with UnitedHealthcare was not made lightly. According to Dr. Nari Hashmati, Chief Clinical Officer of Lee Physician Group, the dispute centers on an estimated $150 million in unpaid and underpaid claims owed by the insurer.
“We’ve been here for a hundred years; we want to be here for another 100 years,” Dr. Hashmati said. “We need those claims paid so we can reinvest that money back into healthcare. Every dollar we don’t get paid is a dollar we don’t have to open up another clinic, to hire another doctor or nurse to provide that level of care.”
UnitedHealthcare countered in statements to Chief WINK Investigates Reporter Chorus Nylander, claiming that Lee Health’s public stance is a negotiating tactic designed to use patients as leverage.
“Lee Health’s abrupt decision to end its commercial and Medicare Advantage contracts at their conclusion was unexpected and came without prior discussions. We believe Lee Health’s actions are linked to the health system’s out-of-network status for our Individual Family Plan (IFP) and that it is now using patients enrolled in our Medicare Advantage and commercial plans as leverage over something that isn’t relevant to them. We remain committed to good-faith discussions with Lee Health focused on reaching an agreement that preserves network access to the health system. We ask that Lee Health share in our commitment to the people we collectively serve and join us at the negotiating table.”
The friction in Lee County is part of a broader trend across Southwest Florida. To the north, Sarasota’s Memorial Healthcare System and First Physicians Group are also terminating their relationship with UnitedHealthcare over similar friction regarding Medicare Advantage policies.
In a released statement, Memorial Healthcare System cited unsustainable administrative terms and coverage denials:
“…Changes to key provisions are making our continued partnership with UnitedHealthcare unsustainable, and UnitedHealthcare refuses to adequately address these concerns.”
Now Advent Health is also cutting ties with Unitedhealthcare. Advent Health is a major healthcare system in Central Florida with a large presence in Charlotte County. This leaves few options for United policyholders if agreements aren’t reached.
As hospital systems in both Lee and Sarasota counties push back against insurer practices, thousands of Southwest Florida residents are left searching for answers before deadline extensions run out.