TUPELO, Miss.—North Mississippi Health Services (NMHS) facilities and providers have terminated agreements with United Healthcare (UHC) Medicare Advantage and Medicaid required Dual Special Needs Medicare Advantage Plans.

NMHS remains in network for commercial/employer sponsored plans (including UMR administered plans), UHC Federal Marketplace plans, UHC MS CAN and CHIP.

Effective June 1, NMHS facilities and providers are now considered out of network for all United Healthcare Medicare Advantage PPO and HMO plans.

NMHS will continue to schedule services for United Healthcare Medicare Advantage PPO plans, as the PPO plans offer out-of-network benefits.

United Healthcare Medicare Advantage HMO plans do not cover out-of-network facilities and providers. Exceptions are generally limited to emergencies and serious medical conditions that require ongoing care, such as cancer treatment or kidney dialysis. These continuity of care situations require written prior approval sent to the member from UHC.

Members should call the customer service phone number on the back of their insurance card to verify benefits and eligibility. Individuals who are being treated for more than one medical condition must complete a separate request for each condition.

Wally Davis, NMHS vice president of Payor Strategy and Partnerships, said NMHS terminated the agreement because patients with these insurance plans were experiencing delayed or denied care.

“We notified UHC Medicare Advantage leadership about this concern in February 2024,” Davis said. “Last month, 42% of inpatient claims at North Mississippi Medical Center-Tupelo were initially denied. Despite following the labor-intensive appeals process and achieving an overturn rate of up to 85% or higher, we never received a definitive answer from UHC on why this was happening.”

Medicare beneficiaries can make changes to their coverage during the Annual Enrollment Period each fall and Open Enrollment Period, which ended March 31.

A Special Enrollment Period is sometimes granted when a member experiences a significant change in his or her provider network. Davis encourages members to call 1-800-MEDICARE to ask about their Special Enrollment Period rights.

More information is also available at medicare.gov, or members can speak with a local insurance agent or broker.

Visit nmhs.net/medicare for more information and a list of affected plans.

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