More and more insurers and hospitals are taking contract fights public — and ripping up longstanding contracts, forcing patients to scramble and suffer as they find new doctors or hospitals.
In Arizona, sick kids with Blue Cross Blue Shield Arizona insurance lost access to Phoenix Children’s Hospital.
On Jan. 1, 2025, Scripps Health and Anthem Blue Cross parted ways in a contract dispute affecting 125,000 patients in San Diego. In 2023, Scripps Clinic and Scripps Coastal in San Diego decided not to accept Medicare Advantage plans any more, saying, “The revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide,” according to reports at the time. That meant that Medicare Advantage patients had to choose another insurer, one that is in contract with Scripps, or to find other doctors.
In Minnesota, Medicare Advantage enrollees were using the Mayo Clinic, then were told they were out of network — although some of them may still be able to use Mayo.
In New York, Memorial Sloan-Kettering Cancer Center and Anthem Blue Cross took their contract fight public, with the suggestion that Anthem insured people would have to stop treatment at Sloan-Kettering because of a contract dispute expiring Dec. 31. But someone blinked — because the two announced on Dec. 23 that they had come to terms and that Sloan-Kettering would remain in network for employer plans and also for Medicaid managed care and Essential Plan members.
Age-old conflict
What’s happening? It’s the age-old conflict between insurers and providers. Insurers say providers are charging too much, are being profligate with supplying services, are giving services that do not have medically proven benefits, and are making too much money because there are no back-checks. Providers say insurers are counting beans, harming patients, limiting treatments prescribed by doctors and otherwise trying to save money at all costa by denying care.
Insurers portray themselves as the good guys fighting unnecessary and expensive care, and providers say insurers have no business denying care because they are not doctors.
So hospitals blame insurers, and insurers blame hospitals. In many cases, one side or the other will issue public appeals to patients to help them get what they want (hospitals, higher prices, or insurers, lower prices) by appealing to hospital or insurance management.
There seem to be more and more of these cases recently. We encountered one way back in 2014, when Stanford ended a contract with Anthem — and Anthem fired back, with public statements saying that our data in our project with KPCC public radio proved that Stanford was overcharging. The dispute was ultimately settled with a contract agreeable to both sides.
Minnesota disputes
The Minnesota Attorney General’s office recently reported a slew of such disputes: Allina, Avera and M Health Fairview Health Care System will not accept Humana Medicare Advantage insurance, nor will North Memorial Medical Center and its providers, or Sanford Health.
M Health Fairview Health Care System will not accept Aetna, and Mayo Clinic will not accept HealthPartners Medicare Advantage.
Keith Ellison, the Minnesota attorney general, issued a statement about this in late November, before the Medicare open enrollment period for 2025 closed on Dec. 7, warning Minnesotans to inspect their coverage, because these changes might mean they cannot see their current doctors, or if they want to see those doctors, they are likely to have to pay.
“Health care costs and medical debt are already challenging for far too many Minnesotans. And that could get worse if folks aren’t able to make informed decisions. I want to make sure that Minnesotans in every corner of our state take the time to get the facts about which providers and Medicare Advantage plans in their area are working together, [and] which are not. I don’t want anyone left holding a bill they didn’t expect, or one they can’t pay just because they didn’t have the facts to begin with,” Ellison said in a press conference, according to Fox 9 in Minneapolis.
Mayo is out, then in
In early 2022, Mayo Clinic started notifying some Medicare Advantage patients in Minnesota, Arizona and Florida that it would not cover them. Mayo has long been out of network for most Medicare Advantage plans, but historically treated out-of-network Medicare Advantage patients and accepted their benefits, according to press reports.
“According to the Star Tribune, the change occurred because Mayo saw a significant increase in patients covered by ‘non-contract’ MA insurers. That increase, officials said, threatens to crowd out patients covered by in-network insurers,” Healthcare Finance reported. The issue was portrayed as one of Mayo lacking capacity, meaning that in-network patients were not being seen, as opposed to one of reimbursement rates.
Then in mid-2022, Mayo established a multi-year Medicare Advantage relationship with UnitedHealth.
On its website, Mayo says it accepts some Medicare Advantage plans, but seemingly only in Minnesota, not in Florida or Arizona.
There have been other breakups: Baton Rouge General hospital in Louisiana left Aetna’s Medicare Advantage plans and Baptist Health in Kentucky left UnitedHealthcare and Wellcare Advantage plans. The The Albany Medical Center system and Humana’s Medicare Advantage plan parted ways also.
Sometimes the disputes are publicly heralded by both sides, and then an agreement comes at the last minute.
“In North Carolina, UNC Health and UnitedHealthcare renewed their contract just three days before it would have expired, and only two days before the deadline for Advantage members to switch plans,” Susan Jaffe wrote at KFF HealthNews in March. “And in New York City, Aetna told its Advantage members this year to be prepared to lose access to the 18 hospitals and other care facilities in the NewYork-Presbyterian Weill Cornell Medical Center health system, before reaching an agreement on a contract last week.”
What you can do
If a Medicare Advantage enrollee wants to go to a provider that doesn’t accept M.A., they need to enroll in traditional Medicare and, commonly, sign up for a Part G Medigap supplemental plan. In four states (Connecticut, Massachusetts, Maine and New York), the switch can be made without a penalty, but in most states, the enrolling Plan G can conduct an underwriting assessment of the new enrollee — asking health questions and looking for pre-existing conditions, and may impose an extra premium bump for that reason. Read more in our Medicare overview.
Most Medicare members have two chances to change plans: during the annual open enrollment period in the fall, which ended this year on Dec. 7, and in the Medicare Advantage switching period from January until March 31.
But there are some provisions for people who experience severe difficulties from a change in insurance.
“A few years ago, CMS created an escape hatch by expanding special enrollment periods, or SEPs, which allow for ‘exceptional circumstances.’ Beneficiaries who qualify can request SEPs to change plans or return to original Medicare,” Jaffe wrote.
“According to CMS rules, there’s an SEP patients may use if their health is in jeopardy due to problems getting or continuing care. This may include situations in which their health care providers are leaving their plans’ networks, said David Lipschutz, an associate director at the Center for Medicare Advocacy.”
Another SEP is available for beneficiaries who experience “significant” network changes, she added. In 2014, CMS offered this SEP to UnitedHealthcare Advantage members when the insurer terminated contracts in 10 states.
‘Continuity of care’
There’s also a doctrine called “continuity of care,” by which a patient with a serious illness or condition is supposed to be able to continue treatment with a medical team for at least a certain amount of time if insurance changes kick them out of network. In practical terms, most people don’t know about continuity of care, and it can be hard to establish, from anecdotal reports.
The information about this program can be hard to gather. Here’s a Massachusetts Blue Cross application, but a normal civilian would be hard put to find it.
The idea is to prevent gaps in care, and to have an orderly transition — if necessary — from one group of providers under one insurance plan to another. In many policies, the transitional period seems to be 90 days, but in all cases it’s necessary to get with the current group and the future group to arrange the transition. Social workers at a hospital group can be helpful. Also there may be local advocacy groups; the New York Statewide Senior Action Council, for example, or the State Health Insurance Assistance Programs, or the Senior Medicare Patrol.
Continuity of care is also supposed to apply in other circumstances — for example, a transition from Medicaid to marketplace insurance. I have a friend who successfully invoked continuity of care when switching from one insurer to another in the middle of cancer treatment, when she thought her old group was out of reach with the new plan.
While the practice of continuity of care exists in principle, it is still true that the U.S. healthcare system is in crisis, and doctor appointments may be scheduled months out even in-network, meaning that continuity of care for 90 days may be less than meaningful.
