Essentia Health Refusing Some Medicare Advantage Insurance Plans

FARGO, N.D. (KVRR/KFGO) — Essentia Health will no longer accept Medicare Advantage insurance plans administered by United Healthcare and Humana.

Essentia has started to inform patients that, due to excessive prior authorization requirements and denial of care, it will no longer serve as an in-network provider effective January 1.

They say UHC and Humana delay and deny approval of care at more than twice the rate of other Medicare Advantage plans, which can cause unnecessary hardships for many Essentia patients.

Those with a UHC or Humana Medicare Advantage plan can choose an alternative option during Medicare open enrollment, from October 15 through December 7.

“Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place added strain on our patients by too often denying or delaying their care,” said Dr. Cathy Cantor, Essentia’s chief medical officer for population health.”

“This was not a decision we made lightly,” Dr. Cantor said. “The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.”