Six Months Later: The Ongoing Divide Between UF Health and United Healthcare Explained

Dr. Marvin Dewar has encountered a lot during his career as an attorney, doctor, and health care executive. He now serves as the CEO and chief medical officer for UF Health Physicians. However, he has never seen negotiations with a health care company last this long.

This Saturday marks six months that the University of Florida Health system has been out of network with United Healthcare. As a result, around 75,000 individuals in Gainesville, Jacksonville, and Central Florida with United insurance are facing significantly higher healthcare costs.

Dewar mentions that UF Health and United are getting closer to an agreement on how the health care provider will be reimbursed for its Medicaid coverage. The major sticking point is whether UF Health will be compensated for the Medicaid services provided while United was out of network.

Medicaid, a federal and state program, helps those with limited income cover medical expenses. In Florida, the Agency for Health Care Administration oversees Medicaid. In January, Duval County had over 220,000 residents enrolled in Medicaid, making it the county with the highest percentage at 22.2%, more than any other area served by UF Health.

While the Medicaid discussion is critical, the negotiations on private insurance may have a bigger impact on patients. Dewar explains that United’s latest offer from January doesn’t reflect the increasing healthcare costs since the last contract was signed. He believes United has made some progress but that significant gaps still need to be closed. One of the challenges is that UF Health is not being adequately reimbursed for the care they provide.

On its website, United states that it wants to finalize an affordable agreement quickly. They highlighted their commitment through numerous meetings over the past weeks. In their view, reaching a deal is essential for providing families in Florida with affordable healthcare.

Despite these efforts, the two sides remain apart. Time is critical as rising healthcare costs continue to strain hospitals. A recent survey found that hospital financial leaders are concerned about maintaining financial stability, primarily by negotiating better rates with insurance providers and managing labor costs.

The 2023 KFF poll of insured adults revealed that 58% faced issues accessing their insurance benefits in the previous year. Many reported serious health and financial consequences due to insurance problems, such as delayed or denied claims.

In a previous interview, Dewar noted that United is a leader in denying claims, making it difficult for UF Health to make an agreement. Claim denials have been a major hurdle in these negotiations.

Recently, a tragedy struck the health care insurance sector with the death of United Healthcare CEO Brian Thompson. His passing led to discussions about insurance claim denials in healthcare services. Following this, United released a fact sheet stating they approve 90% of claims, attributing denials to correctable administrative errors. However, Dewar disagrees, stating that around 20% to 30% of claims submitted by UF Health are denied.

Dewar emphasizes the need to close the gap in reimbursements. He stated, “We are not happy being out of network, but we must resolve this issue on the commercial side. Once United can find a way to close this gap—whether through higher reimbursement rates or other tangible solutions—we can return to being in-network.”

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