This is a developing story. Check back for updates.
UF Health patients using UnitedHealthcare could lose coverage beginning Sept. 1.
The two entities have been in contract negotiations for the past several months. UF Health, which operates 12 hospitals and more than 140 primary care practices throughout the state, said it is still waiting for United to respond with a “fair and sustainable offer.”
That includes streamlining claims processes and reducing administrative demands, UF Health said in a statement to The Alligator.
“Insurers like UnitedHealthcare have reported billions in record profits while health systems like UF Health have shouldered growing costs while striving to fulfill the mission of serving patients and the community,” the statement said.
Unless there is a change in circumstances by the end of August, thousands of patients across Florida will experience an “unnecessary disruption” to continuous care access, UF Health said.
United claimed on a website announcement updated Aug. 28 that UF Health is demanding a more than 25% price hike in the first year of its commercial contract.
The insurance company also alleges UF Health has repeatedly “refused” to finalize the agreed-upon terms for Medicaid users amid negotiations over commercial rates.
“We can only assume UF Health’s intentions are to leave our network given their continued demands for outlandish rate increases that aren’t acceptable or affordable for the people we collectively serve,” United said.
Statewide, United insures 3.7 million Floridians across about 250 hospitals. It reported posting $371.6 billion in annual revenue in 2023, a 14.6% increase from the previous year.
Student coverage
UF students who receive United coverage through the university’s student health insurance plan will still be able to receive care at all UF Health facilities with no impact, regardless of the outcome, UF Health said.
Students covered through their parents can still receive care at the on-campus UF Student Health Care Center in Gainesville but not at other UF Health locations, it said.
However, United did not clarify whether students would be exempt from losing coverage in its own statement to The Alligator.
Instead, a spokesperson said in an email statement that all UF Health’s hospitals, facilities and physicians will be out of network for people using all commercial, Medicaid and Student Resources plans by September if an agreement is not reached.
When the discrepancy was brought to UF Health’s attention, the organization reiterated students will not be affected and suggested United might have omitted the exception from its statement because its contract with UF Health is different from its contract with UF Student Services. The latter pays the insurance company to coordinate student healthcare.
About 5,000 to 7,000 students are currently on the United Student Resources plan, according to a UF public records request. Students are required to purchase this plan unless they can prove that they already have comparable coverage.
A basic annual United Student Resources plan for UF students cost $3,135 for the 2024-2025 school year, according to a policyholder application document provided to The Alligator. The academic year plan is effective from Aug. 16, 2024 through Aug. 15, 2025.
Non-student coverage, including Medicare and Medicaid
Non-student patients who are insured through their employers or have Medicaid plans will lose coverage at UF Health locations throughout the state Sept. 1, United said.
The only people who will lose Medicare coverage are those at UF Health St. Johns, which became a part of the UF Health organization last year.
Of the 64,000 people aged 65 and older living in St. Johns County, 96.7% have Medicare coverage, according to 2022 data from the U.S. Census Bureau.
The county does not differ significantly from the state average in the percent of its population made up of elderly people or the percent of those people who use Medicare. Neither UF nor United specified why only St. Johns patients will lose Medicare coverage.
People who use Medicare plans at other UF Health hospitals and providers, like UF Health Gainesville, Jacksonville or The Villages Regional Hospital, will receive care as usual.
UF Health’s psychiatric hospital and its UF Health Central Florida facilities will not be impacted. They will remain in network regardless of the negotiation’s outcome, according to United.
United is proposing rates that ensure UF Health is reimbursed similar to peer health systems, while ensuring health care is affordable for consumers and companies in North Florida, the insurance company said in its statement.
“We urge the health system to approach our negotiation with a proposal Florida families and local businesses can afford,” it said.
United alleges on its website UF Health’s rate demands would increase health care costs for self-insured customers who pay the cost of their employee’s medical bills.
Twenty of these self-funded businesses would see health care costs go up by $200,000 or more in a single year, the insurance company alleges, giving employers less money to help grow their businesses.
UF Health’s proposal would also raise hospital prices for consumers, United said. For example, the company said someone with a 20% co-insurance could expect to pay $1,000 more out of pocket than they do now, on average, for a C-section at UF Health Jacksonville under the medical network’s proposal.
United has disputed with health systems throughout the country over the past several months.
That includes Duke Health, based in North Carolina, where patients will lose coverage at the end of October if the network does not reach a deal. Minnesota nonprofit provider HealthPartners will also leave United’s Medicare Advantage network starting next year.
In its online statement, United also answered frequently asked questions about the dispute with UF Health.
People in the middle of a treatment, including pregnant people or newly diagnosed cancer patients, may qualify for continuity of care programs even if UF Health and United do not reach an agreement, the website said. These patients have until Sept. 30 to apply.
Contact Zoey Thomas at zthomas@alligator.org. Follow her on X @zoeythomas39.
Zoey Thomas is a media production junior and the Fall 2024 Enterprise Health Reporter for The Alligator. She previously worked on the University and Metro desks. Her most prized assets include her espresso machine, Regal Unlimited movie pass and HOKA running shoes.
