![\"Miami,](\"https:\/\/www.newsbeep.com\/us-fl\/wp-content\/uploads\/2026\/07\/MIA_UHEATHSOLEOPENING32.JPG\" "\\"An")
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An operating room of the University of Miami Health System’s UHealth SoL\u00e9 Mia Medical Center.<\/p>\n
Alexia Fodere<\/p>\n
for Miami Herald<\/p>\n
South Florida patients insured through UnitedHealthcare could be locked out of in-network care at the University of Miami Health System as soon as August if a deal isn\u2019t made soon.<\/p>\n
UHealth is sounding the alarm over its ongoing contract negotiations with UnitedHealthcare, the largest health insurer in the country with millions of members. It\u2019s accusing UnitedHealthcare of not paying its doctors enough for care and \u201cputting profits ahead of South Floridians\u2019 care.\u201d<\/p>\n
UnitedHealthcare, whose parent company is UnitedHealth Group, meanwhile, is accusing UHealth of seeking \u201csignificant price hikes that would increase health care costs for families and employers.\u201d<\/p>\n
The two have until July 31 to reach a deal. If they don\u2019t, UHealth will become an out-of-network provider starting Aug. 1.<\/p>\n
This is the latest South Florida hospital versus health insurer dispute to go public. Thousands of people insured through Florida Blue, one of the largest health insurers in the state, are still out-of-network at Broward\u2019s two public hospitals due to stalled contract negotiations.<\/a> Broward Health and Memorial Health have accused Florida Blue of not paying them enough for care, while the health insurer is accusing them of wanting too much money. Negotiations remain ongoing.<\/p>\n Here\u2019s what else to know:<\/p>\n How will it affect patients?<\/p>\n If the two parties can\u2019t make a deal, then UHealth hospitals, facilities and physicians will be out-of-network starting Aug. 1 for patients who have health insurance through UnitedHealthcare\u2019s network. The health insurer said that includes employer-sponsored commercial plans, Medicaid (UnitedHealthcare Community Plan of Florida) and Individual Family Plans (IFP), which are health insurance plans a person purchases on their own, usually through the Affordable Care Act (ACA) marketplace.<\/p>\n Patients enrolled in UnitedHealthcare\u2019s Medicare Advantage Preferred Care Network plan would still have access to UHealth facilities and doctors due to a separate agreement, according to UnitedHealthcare.<\/p>\n If UHealth goes out-of-network, patients will either have to search for a new in-network doctor or get stuck paying a heftier bill out of pocket to continue getting care with their UHealth specialists, including at Bascom Palmer Institute, which has long reigned as the top hospital for eye care in the nation, and Sylvester Comprehensive Cancer Center, the only National Cancer Institute-designated cancer center in the region.<\/p>\n It\u2019s not clear how an out-of-network UHealth would affect, if at all, the ongoing partnership between UM\u2019s medical school and Jackson Health System, Miami-Dade\u2019s public health system, which has long served as UM\u2019s teaching hospital. Jackson and its Miami Transplant Institute, for example, use doctors from the University of Miami Health System.<\/p>\n What about patients with cancer or other conditions?<\/p>\n It\u2019s worth noting that if UHealth were to go out-of-network, patients who are undergoing treatment for serious or complex conditions, such as people who are pregnant or are currently undergoing active cancer treatment, would be eligible to continue receiving in-network care with UHealth for 90 days due to a federal law that requires insurers to provide continuity of care.<\/p>\n \u201cUnitedHealthcare members must apply and be approved for continuity of care. People can apply at any time from now through 30 days after a provider has left our network,\u201d UnitedHealthcare wrote on a webpage<\/a> about the ongoing negotiations. \u201cThey should call the number on their health plan ID card if they need assistance or have questions.\u201d<\/p>\n Can you still use the ER if UHealth goes out-of-network?<\/p>\n The good news is that UnitedHealthcare, like most health insurers, is required by law to cover emergency care at UHealth and other ERs at in-network rates, even if the emergency room is out-of-network.<\/p>\n It doesn\u2019t matter if the patient is hospitalized or goes home the same day. If it\u2019s an emergency, health insurance will cover it at in-network rates, according to Patricia Kelmar, senior director of healthcare campaigns at PIRG<\/a>, a nonprofit that advocates for consumer protections, public health and environmental sustainability.<\/p>\n But beware: ER doctors decide the necessary treatment, but it\u2019s the health insurer that ultimately determines whether the provided services fall under emergency care for in-network rates, Kelmar previously told the Miami Herald.<\/p>\n TIP: ERs are meant for life-threatening or potentially life-threatening symptoms and conditions, such as if you\u2019re struggling to breathe or have chest pain or numbness on one side of the body. Urgent care is the place to start for everything else, like a cough, sore throat, runny nose or diarrhea. Urgent care visits are also cheaper.<\/p>\n UHealth accused UnitedHealthcare of \u2018delay and deny\u2019 tactics<\/p>\n Hospitals and health insurers undergo contract negotiations all the time. Sometimes, those disputes go into the public eye.<\/p>\n \u201cWhile the cost of healthcare, nurses, and medical supplies keeps going up, UnitedHealthcare is not reimbursing<\/a> at rates that keep pace. We need United to agree to a new agreement so UHealth can continue delivering the high-quality care patients and families rely on from the region\u2019s only academic medical center,\u201d UHealth wrote on a webpage about the ongoing negotiations.<\/p>\n \u201cUnited made $9 billion in profits in just the first three months of this year, but they refuse to pay UHealth the same rates they already pay other hospitals in South Florida,\u201d said the health system. \u201cThis isn\u2019t just happening here. Across the country, United has repeatedly put profits ahead of patients\u2019 access to care in other negotiations.\u201d<\/p>\n It\u2019s not just reimbursement rates that have UHealth fuming. The health system says it\u2019s also fed up with the \u201cdelay and deny care\u201d tactic the health insurer uses, despite 94% of the denials later being overturned and approved.<\/p>\n \u201cThese unnecessary delays take valuable time away from care teams \u2014 time that should be spent caring for patients, not battling red tape,\u201d UHealth wrote.<\/p>\n UHealth has also pointed to a proposed policy by United that it claims \u201ccould force patients receiving ongoing infusion treatment, such as chemotherapy, to leave UHealth in the middle of their care.\u201d<\/p>\n UnitedHealthcare accuses UHealth of using patients as \u2018leverage\u2019<\/p>\n UnitedHealthcare, on its own negotiation webpage, said it negotiates thousands of contracts each year and while \u201cthe vast majority are resolved with no disruption to in-network care\u201d some health systems, like UHealth, \u201cchoose to negotiate publicly, putting their patients in the middle of these discussions as potential leverage to obtain the price increases they are seeking.\u201d<\/p>\n UnitedHealthcare, in its post, explained that \u201chealth care costs are directly affected by the reimbursement we negotiate with health systems in our network\u201d and that \u201cone of the leading drivers of rising health care costs are the prices hospitals charge.\u201d<\/p>\n And the rates UHealth wants are just too costly, according to UnitedHealthcare.<\/p>\n \u201cWe are proposing rate increases that continue to reimburse UHealth similar to its peers throughout the region while balancing the need for affordable care for hard-working families and employers already struggling during challenging economic times,\u201d the health insurer wrote.<\/p>\n Michelle Marchante<\/a><\/p>\n Miami Herald<\/p>\n Michelle Marchante covers the pulse of healthcare in South Florida and also the City of Coral Gables. Before that, she covered the COVID-19 pandemic, hurricanes, crime, education, entertainment and other topics in South Florida for the Herald as a breaking news reporter. She recently won first place in the health reporting category in the 2025 Sunshine State Awards for her coverage of Steward Health\u2019s bankruptcy. An investigative series about the abrupt closure of a Miami heart transplant program led Michelle and her colleagues to be recognized as finalists in two 2024 Florida Sunshine State Award categories. She also won second place in the 73rd annual Green Eyeshade Awards for her consumer-focused healthcare stories and was part of the team of reporters who won a 2022 Pulitzer Prize for the Miami Herald\u2019s breaking news coverage of the Surfside building collapse. Michelle graduated with honors from Florida International University and was a 2025 National Press Foundation Covering Workplace Mental Health fellow and a 2020-2021 Poynter-Koch Media & Journalism fellow.\u00a0
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