Minneapolis-based Allina Health, a 12-hospital system, has notified about 18,000 patients with Humana Medicare Advantage plans that their clinicians will be out-of-network in 2025 unless the payer agrees to a contract that reduces prior authorization hurdles and claims denials, The Star Tribune reported Oct. 24.
"It's important that Humana agree to a contract that reduces administrative burden, eliminates friction for patients and providers and keeps up with the rising cost of providing outstanding care," a spokesperson for Allina said in a statement shared with Becker's. "We continue to negotiate with Humana and hope to reach an agreement that allows us to remain in-network in 2025 so that patients can keep their preferred Allina Health providers and hospitals."
Humana said it has engaged in good-faith discussions with Allina and proposed solutions to meet their requests.
"Allina Health's current demands overlook the value that Medicare Advantage plans provide, such as lower out-of-pocket costs, higher quality care than traditional Medicare and benefits that matter most to our members," Humana said in a statement. "We remain open to renewing a contract with Allina that is fair and beneficial for both parties."
So far this year, almost 30 other health systems have opted to end their MA contracts with commercial payers due similar administrative challenges. About 13 hospitals and health systems elected to do the same in 2023.
In Minnesota, four other nonprofit systems have signaled their intent to go out-of-network with Humana MA plans in 2025, and a fifth will go out-of-network with UnitedHealthcare's MA plan, according to the Tribune. One system is set to leave MA networks at both Humana and UnitedHealthcare:
- Duluth, Minn.-based Essentia Health will no longer accept UnitedHealthcare and Humana MA in 2025.
- Sioux Falls, S.D.-based Sanford Health is dropping Humana MA in Minnesota in 2025.
- Bloomington, Minn.-based HealthPartners will no longer be in network with UnitedHealthcare MA plans by 2025.
- Sioux Falls, S.D.-based Avera Health, which operates three hospitals in southwest Minnesota, will end participation as an in-network provider with Humana MA on Dec. 31.
- Robbinsdale, Minn.-based North Memorial Health, a two-hospital system, is ending its contract with Humana MA, effective Dec. 31.