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Lee Health\u2019s Gulf Coast Medical Center in south Fort Myers. The healthcare system plans to end its commercial and Medicare Advantage contracts with UnitedHealthcare on Jan. 1, 2027, potentially affecting access to in-network care for about 50,000 Southwest Florida patients.<\/p>\n
Lee Health<\/p>\n
Tens of thousands of Southwest Florida patients face uncertainty over their healthcare coverage following Lee Health\u2019s decision to end its commercial and Medicare Advantage contracts with UnitedHealthcare effective Jan. 1, 2027.\u00a0<\/p>\n
The change would not eliminate patients\u2019 UnitedHealthcare insurance coverage, but it could leave Lee Health and its physicians\u2019 groups out of network, potentially affecting access to care and out-of-pocket costs. Emergency care and certain continuity-of-care exceptions may still apply.\u00a0<\/p>\n
The uncertainty is especially acute for Medicare Advantage patients, since Medicare Annual Enrollment opened Oct. 15 and closes Dec. 7.\u00a0<\/p>\n
Private nonprofit Lee Health, the largest healthcare system in the region and one of the largest in the state, says it notified about 50,000 patients by letter in late August about the change.\u00a0<\/p>\n
Lee Health did not have data immediately available on how many of those patients are from Collier County or other areas outside Lee County.\u00a0<\/p>\n
In the letter sent to patients, Lee Health said it made the decision after \u201cyears of good-faith discussions and efforts to resolve significant concerns,\u201d including the impact it says UnitedHealthcare\u2019s authorization, review and denial processes can have on timely access to medically necessary care.\u00a0<\/p>\n
The letter also said the healthcare system was owed more than $100 million by UnitedHealthcare in disputed and underpaid claims.\u00a0<\/p>\n
In mid-October, Lee Health revised that figure to $150 million.\u00a0<\/p>\n
UnitedHealthcare disputes those claims, saying in a statement that Lee Health\u2019s decision came without advance notice and denying that it owes \u201cmore than $100 million\u201d or any amount to Lee Health. The insurer says the allegation is unrelated to commercial or Medicare Advantage contracts and involves a dispute currently proceeding through arbitration.\u00a0<\/p>\n
Tough negotiations between healthcare systems and insurers are not uncommon, and agreements are often reached just before contracts expire. While Lee Health and UnitedHealthcare disagree over what led to the current impasse, Medicare Advantage patients are left to make insurance coverage decisions without knowing whether the dispute will be resolved before Medicare Annual Enrollment ends Dec. 7.\u00a0<\/p>\n
Lee Health\u2019s case for terminating UnitedHealthcare\u00a0\u00a0<\/p>\n
Dr. Nariman Heshmati, chief clinical officer for Lee Physician Group and Ambulatory Care Services, says the current situation is not a conventional negotiation over reimbursement rates.\u00a0<\/p>\n
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Dr. Nariman Heshmati<\/p>\n
Lee Health<\/p>\n
In an interview, Heshmati said Lee Health has \u201cbeen at the table with them (UnitedHealthcare) for years\u201d over unpaid claims for services delivered and denials of coverage.\u00a0<\/p>\n
\u201cA third of our medically necessary denials are United, and the majority of those are overturned on appeal,\u201d Heshmati said. \u201cUltimately, what it came down to is that somebody\u2019s got to speak up for the patients.\u201d\u00a0<\/p>\n
Heshmati said Lee Health has not gone out of network with an insurer in more than 20 years and that the system views leaving the UnitedHealthcare network as necessary for its long-term ability to provide care for patients.\u00a0<\/p>\n
Asked if he sees a path forward for resolving the ongoing disputes, Heshmati said, \u201cwe need to do more than talk.\u201d\u00a0<\/p>\n
\u201cWe need to see actions that actually improve the relationship, that improve the ability to provide that patient care,\u201d Heshmati said. \u201cWhether it was United or anybody else, we just want the ability that we\u2019re paid for care provided. We want the ability that if a physician has care that they have discussed with a patient that\u2019s in their best interest, they can provide that care without unnecessary prior authorizations or without denials that get overturned later that just delay a patient\u2019s care.\u00a0<\/p>\n
\u201cThat\u2019s the kind of relationship we need.\u201d\u00a0<\/p>\n
UnitedHealthcare pushes back\u00a0\u00a0<\/p>\n
For its part, UnitedHealthcare strongly rebuts Lee Health\u2019s contentions, saying in its statement that the system\u2019s \u201cabrupt\u201d decision to end its commercial and Medicare Advantage contracts at year\u2019s end was unexpected and came \u201cwithout prior discussions.\u201d\u00a0<\/p>\n
The statement said UnitedHealthcare believes Lee Health\u2019s actions are related to the system\u2019s out-of-network status for UnitedHealthcare\u2019s Individual Family Plan and that it is \u201cnow using patients enrolled in our Medicare Advantage and commercial plans as leverage over something that isn\u2019t related to them.\u201d\u00a0<\/p>\n
Lee Health is already considered out of network by UnitedHealthcare for its Exchange\/Marketplace plans, a separate issue from the commercial and Medicare Advantage contracts scheduled to end Jan. 1.\u00a0<\/p>\n
\u201cWe remain committed to good faith discussions with Lee Health focused on reaching an agreement that preserves network access to the health system,\u201d the statement continued. \u201cWe ask that Lee Health share in our commitment to the people we collectively serve and join us at the negotiating table.\u201d\u00a0<\/p>\n
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Lee Memorial Hospital in Fort Myers is part of Lee Health, which plans to end its commercial and Medicare Advantage contracts with UnitedHealthcare on Jan. 1, 2027. The dispute could affect access to in-network care for about 50,000 Southwest Florida patients.<\/p>\n
Gulfshore Business<\/p>\n
Asked if Lee Health would return to negotiations with UnitedHealthcare in an effort to stay in network with the insurer, spokesperson Jaclyn Bevis Berger said in a statement that Lee Health \u201chas been at the table with UnitedHealthcare for years, working in good faith to address longstanding concerns involving patient access to care, administrative barriers and payment practices.\u201d\u00a0<\/p>\n
She said Lee Health \u201cremains responsive to UnitedHealthcare and committed to supporting patients through this transition.\u201d\u00a0<\/p>\n
If Lee Health goes out of network with UnitedHealthcare on Jan. 1, other area healthcare systems that will remain in network with the insurer for commercial and Medicare Advantage plans in 2027 include Physicians Regional and Naples Comprehensive Health, both in Collier County.\u00a0<\/p>\n
Brittney Thoman, system director of marketing and public relations for Physicians Regional Healthcare System, said in a statement that the for-profit system\u2019s primary care and specialist physicians \u201cwelcome new patients needing our care, including those who are affected by changes in their commercial insurance or Medicare plan networks.\u201d\u00a0<\/p>\n
NCH Communications Director Shawn McConnell said in a statement that the nonprofit healthcare system, the largest in Collier County, \u201cis here to serve all of Southwest Florida.\u201d McConnell said NCH will continue to accept UnitedHealthcare commercial and Medicare Advantage plans in 2027 and welcomes patients affected by potential network changes.\u00a0<\/p>\n
NCH trims two Medicare Advantage plans\u00a0\u00a0<\/p>\n
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Danny Hogan<\/p>\n
Naples Comprehensive Health<\/p>\n