![\"UHealth](\"https:\/\/www.newsbeep.com\/us-fl\/wp-content\/uploads\/2026\/07\/IMG_emergency_room_medic_3_1_L5N8SA00_L761732318.JPG\" "\\"UHealth")
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UHealth and United Healthcare are in contract negotiations.<\/p>\n
McClatchy File<\/p>\n
South Floridians enrolled in certain Medicare Advantage plans could soon find themselves locked out of in-network care with the University of Miami Health System.<\/p>\n
UHealth patients insured through a Medicare Advantage plan that is part of Florida\u2019s Preferred Care Network, a UnitedHealthcare-owned company, are on notice: If UHealth and United don\u2019t make a new contract soon, their primary and specialty doctors at UHealth could be out-of-network with the insurer as early as September.<\/p>\n
Patients with Medicare Advantage plans through the Preferred Care Network have told the Miami Herald they\u2019ve begun to receive letters from United warning them about the potential coverage change.<\/p>\n
United, the largest health insurer in the nation, confirmed to the Herald this week that the warning comes as it continues to negotiate \u201cin good faith\u201d to try and strike a deal with the private health system. And the deadline to make a deal is nearing, both for Preferred Care Network members and for members enrolled in commercial and Medicaid plans.<\/p>\n
The heated negotiations are over reimbursement rates<\/a>. UHealth is accusing United of not paying it enough for care. United is accusing UHealth of wanting too much money. It\u2019s similar to the still ongoing and stalled contract disputes<\/a> between Broward\u2019s public health systems and Florida Blue, one of the largest insurers in the state.<\/p>\n Here are the key things to know.<\/p>\n When would Medicare Advantage, other United members go out-of-network?<\/p>\n If UHealth and United don\u2019t make a deal, the hospital system \u2014 including the renowned Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute \u2014 would be out-of-network within the next two months for thousands of people across South Florida enrolled in United-managed plans.<\/p>\n If a deal is not made, members insured through United\u2019s Preferred Care Network Medicare Advantage plans would be out-of-network with UHealth starting Sept. 1. UHealth is already out-of-network for all other United Healthcare Medicare Advantage plans.<\/p>\n For all other United members, if no agreement is reached, UHealth would be out-of-network even earlier, starting Aug. 1. That includes people with employer-sponsored commercial plans, Medicaid (UnitedHealthcare Community Plan of Florida) and Individual Family Plans, which are health insurance plans a person purchases on their own, usually through the Affordable Care Act marketplace.<\/p>\n Where else can patients get care?<\/p>\n UnitedHealthcare says it has a \u201clarge network of providers\u201d across South Florida, including Baptist Health Medical Group, HCA Florida Mercy Hospital, Nicklaus Children\u2019s Hospital and Mount Sinai Medical Center.<\/p>\n South Florida\u2019s three public hospital systems \u2014 Jackson Health System in Miami-Dade County and Broward Health and Memorial Healthcare System in Broward County \u2014 all accept some United health insurance plans, according to their websites.<\/p>\n The fastest way to find a doctor near you is to use United\u2019s online doctor search<\/a>. Patients should always call to double-check that the provider will accept your insurance.<\/p>\n What is Florida Preferred Care Network?<\/p>\n United\u2019s Preferred Care Network Medicare Advantage plans provide health maintenance organization (HMO) plans with prescription drug coverage across Miami-Dade and Broward counties. Some plans may also offer additional benefits<\/a>, including vision, dental, rides to appointments, over-the-counter medications and a fitness program.<\/p>\n Over 41,000 people across Miami-Dade and Broward counties are enrolled in plans<\/a> through Preferred Care Network, according to the National Committee for Quality Assurance (NCQA), an organization that measures and accredits health plans.<\/p>\n Patients with HMO plans are required to choose a primary care provider<\/a> as their main doctor and must get care with doctors and other providers who are in the plan\u2019s network and service area. United Healthcare describes HMO plans as an insurance that usually offers lower premiums, deductibles and cost-shares. However, there\u2019s also no out-of-network coverage with an HMO plan.<\/p>\n \u201cIf you get care from any out-of-network provider (like a doctor, surgeon or lab for bloodwork), you\u2019ll be required to pay the full cost of that service,\u201d reads United Healthcare\u2019s website. \u201cThe only time an HMO plan will cover out-of-network services is if it\u2019s emergency care.\u201d<\/p>\n READ MORE: Should you get original Medicare or an Advantage plan? Here\u2019s what to know<\/a><\/p>\n How will an out-of-network status for UHealth affect patients?<\/p>\n If no deal is made, people with the aforementioned health insurance plans through United will no longer be able to get in-network care with UHealth doctors and other providers across UHealth\u2019s South Florida facilities. That means you\u2019ll either have to change doctors or pay out-of-pocket for treatment. And that can be costly.<\/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 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 What about emergency care?<\/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 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 Loading\u2026<\/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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