About 2,300 retirees from St. Paul Public Schools are among those directly caught up in HealthPartners’ decision to drop out of the network next year in UnitedHealthcare’s Medicare Advantage plan for seniors.
The school district said in a statement to the Star Tribune that it’s working with insurance providers to “identify potential next steps,” but it did not elaborate on what options might be available.
The change raises questions about how, whether and at what cost seniors in UnitedHealthcare’s Medicare Advantage plan will be able to visit doctors, clinics and hospitals next year within the HealthPartners network.
The Bloomington-based health system has a particularly large presence in the east metro, including Regions Hospital in St. Paul and Lakeview Hospital in Stillwater.
“As soon as we have more information, the district will communicate with the impacted retirees about their options,” the district said in a statement.
HealthPartners alleged in letters sent to about 30,000 affected patients that UnitedHealthcare had an excessively high rate of coverage denials and delays in payment for services used by seniors. UnitedHealthcare said the allegations about denials were outlandish and untrue.
The insurer also said there was still time to reach an agreement to keep HealthPartners in the network for 2025.
Denise Rodriguez, who is a past president of the St. Paul Federation of Educators, said she and her fellow retirees have experienced many delays and denials since the district moved the retiree health plan to UnitedHealthcare a few years ago.
“It’s been very frustrating,” she said.
Rodriguez faces a possible dilemma about what to do next year because she has visited HealthPartners clinics for decades and wants to keep doing so. As a retiree, the cost of her Medicare Advantage plan is subsidized by St. Paul Public Schools, and she would lose that subsidy, she said, if she drops UnitedHealthcare.
The network change won’t take effect until Jan. 1. Some contract disputes are resolved after they become public, meaning health care providers don’t drop out of the network. Furthermore, benefits can change year-to-year, said Joshua Haberman, chief executive of Alexander & Haberman, an insurance agency based in Bloomington.
“There’s a lot consumers don’t know yet about their options for next year,” he said.
In a statement Friday, UnitedHealthcare said people in employer-sponsored retiree plans could still go to HealthPartners facilities next year. Their share of the cost “will be the same in most instances as if the provider was part of the network,” the insurer said.
But HealthPartners said it won’t accept UnitedHealthcare Medicare Advantage insurance on an out-of-network basis starting Jan. 1. In addition, while HealthPartners hospitals would provide emergency care as with all patients, the health system said it will not schedule appointments next year for patients with UnitedHealthcare Medicare Advantage coverage.
“We’ll work with [United] on a process for continuity of care concerns,” HealthPartners said.
Source: St. Paul school retirees caught up in HealthPartners, UnitedHealthcare dispute
