Tupelo, Miss.-based North Mississippi Health Services is out-of-network with UnitedHealthcare Medicare Advantage plans, as of June 1.
The split affects UnitedHealthcare MA and dual-eligible special needs plans. North Mississippi Health Services is still in-network with UnitedHealthcare commercial, individual and Medicaid plans, according to a June 10 news release from the health system.
North Mississippi Health Services chose to split with UnitedHealthcare over delayed and denied claims, Wally Davis, vice president of payer strategy and partnerships at NMHS said.
“Last month, 42% of inpatient claims at North Mississippi Medical Center—Tupelo were initially denied,” Mr. Davis said in the news release. “Despite following the labor-intensive appeals process and achieving an overturn rate of up to 85% or higher, we never received a definitive answer from UHC on why this was happening.”
North Mississippi Health Services operates eight hospitals and more than 70 primary and specialty care clinics.
According to Mississippi Today, around 17,000 United Healthcare MA members live in NMHS’ area, and the majority of these members are patients of the health system.
Across the country, a growing number of hospitals and health systems have chosen to drop some Medicare Advantage plans. Hospitals often cite excessive prior authorization denial rates and slow payments from insurers as the reason for the decision.
In a statement shared with Becker’s, A UnitedHealthcare spokesperson said the insurer offered NMHS “a range of options and solutions” to keep the health system in-network.
“As part of these efforts, we offered to extend our existing contract to provide patients uninterrupted access to the health system while we continue negotiating in good faith. Unfortunately, NMHS refused,” the company said. “Our priority now is providing the people we serve with the care they need, either through continuity of care or by helping them transition to another provider, as appropriate.”
