LOUISVILLE — Citing a “large volume and high frequency” of coverage delays and denials, UofL Health is terminating its partnership with UnitedHealthcare’s Medicare Advantage plan.

The termination goes into effect May 1 for UofL facilities like University Hospital, Jewish Hospital, Mary & Elizabeth Hospital, Shelbyville Hospital, Peace Hospital and outpatient centers, while doctors’ offices will still be in network until May 2026.

UnitedHealthcare said in a statement, “We are early in our discussions with UofL Health. We’re committed to utilizing the more than five months remaining on our contract to engage in good-faith negotiation with the goal of reaching an agreement that is affordable for consumers.”

Kentucky seniors impacted by this news can switch plans under an open enrollment period that ends Dec. 7. They were notified after the termination notice via letters and through brokers.

Paul Nagy, UofL Health’s senior vice president of managed care amd contracting, told the Kentucky Lantern that the timing of the termination announcement “is helpful to the seniors.”

“I think it will be beneficial to those United members to have that opportunity to know and make that informed decision on whether this is something that’s significant to them that would make them want to choose another plan, or perhaps they’re fine to seek care other places,” he said.

In the past year, about 12,000 UnitedHealthcare members have received care at least once from the UofL Health system, Nagy said.

“If all 12,000 were to never, ever get care again, it would not cause UofL Health to have to close any facility, nor would it force us to have to stop providing any of the services that we do today,” Nagy said.

A UnitedHealthcare spokesperson called the timing a “scare tactic.”

“It’s unfortunate UofL Health has put Kentucky seniors in the middle of our negotiation as a scare tactic given we only recently kicked off discussions about a new contract,” the spokesperson said. “We believe UofL Health’s decision to communicate early to our members is nothing more than a negotiating tactic in an effort to elicit a reaction and leverage consumers by creating fear and anxiety.”

In a statement, UofL Health CEO Tom Miller said the termination “has not been an easy decision.”

“United Healthcare is simply not delivering on promises made to its Medicare Advantage patients or providers,” Miller said. “We will not turn away any patient in need of care, but United Healthcare has created an unmanageable process that creates too many administrative hurdles when sick people just need care and the confidence they are covered.”

‘An untenable position.’

UofL Health sent the formal notice of termination to United Healthcare in late October, Nagy said. Their agreement allowed for 180 days notice of termination, which would have been before the May 1 effective date.

Before the termination notice, Nagy said, problems had been going on for “a long period of time” but had increased in frequency.

“Denial is one of the key factors ultimately leading to this decision,” Nagy said. “It’s kind of an odd economic system where we provide the care up front, we have expenses in providing those cares, and then we submit a claim and look to be paid on the back end. And so when denials happen at a large volume and high frequency, it’s detrimental to the financial health of our health system.”

Denials are also “negative” for patients, Nagy said. The system also dealt with approval delays and reimbursement downgrades, he said.

“I am concerned about barriers put up for those that really need care,” Dr. Jason Smith, UofL Health chief medical officer, said in a statement. “We care deeply about our patients and the care they receive, which is why we are unwilling to continue with the status quo. Denials of care and onerous pre-approval processes put our patients, physicians and other providers in an untenable position.”

Baptist Health also cut its agreement with UnitedHealthcare, the Lantern previously reported, citing similar issues as UofL.

“Our track record of renewing contracts with providers is strong,” a United spokesperson said. “We negotiate thousands of provider contracts every year, and the vast majority of those negotiations result in renewed contracts with no disruption for our members, and also no external noise as the negotiations are handled professionally and behind closed doors. We are fully committed to engaging in productive, good-faith negotiation and remain focused on our goal of renewing our contract with UofL Health. We hope UofL Health shares our commitment toward reaching an agreement.”

‘Dysfunctional relationship’

UofL Health still accepts Medicare and other Medicare Advantage plans from other insurance companies. Beginning Jan. 1, UofL will also accept Devoted Health as a new plan, though that was in the works before the United termination, and is not in response to it, Nagy said.

Before terminating the partnership, UofL Health “met with” United to discuss the issues, but ultimately “reached the point where we recognized this was a difficult environment that we would be best to not continue,” Nagy said.

“I think anytime you’re in a dysfunctional relationship — whether that’s business, personal or others — there’s times you may make the decision that it’s just best to part ways and withdraw,” he said. “We’re not out to say that anybody’s a bad, horrible organization. We just felt it would be best for us and for us and for our patient populations to discontinue the partnership.”