Mayo Clinic and UnitedHealthcare reach network agreement - INFORUM

ROCHESTER — Months after Mayo Clinic began turning away patients covered by UnitedHealthcare's Medicare Advantage, the two Minnesota health care giants have "reached an agreement on a new, multi-year network relationship."

In February, the news broke that Mayo Clinic would not treat patients covered by UHC's Medicare Advantage insurance plan. UnitedHealthcare is Minnesota's third-largest Medicare Advantage carrier, with 113,800 members.

Blue Cross Blue Shield Minnesota and UCare Minnesota, the state's largest local Medicare Advantage plans, are both in-network with Mayo Clinic.

At the time, neither Mayo Clinic nor UHC would confirm that the two organizations were in contract negotiations.

Mayo Clinic explained its decision to not treat UHC patients as solely being about "capacity" versus lower reimbursement rates.

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"Mayo simply does not have enough capacity to serve an ever-increasing number of patients. Mayo needs to be good stewards with our contracted plans. This is what drove our decision to enforce our policy consistently," stated Mayo Clinic Spokesperson Karl Oestreich in February.

That changed last week, when Mayo Clinic and UHC announced that an agreement had been reached to provide "in-network" access to UHC Medicare Advantage patients to Mayo Clinic Rochester and Mayo Clinic Health System sites throughout the Midwest starting on Jan. 1, 2023.

"We look forward to building on the continued strong relationship between Mayo Clinic and UnitedHealthcare," stated Mayo Clinic Medical Director for Contracting and Payer Relations Dr. Lyell Jones. "Agreements between Mayo Clinic and leading insurers such as UnitedHealthcare help ensure access for patients who need serious and complex care."

While the Mayo/UHC deal is described as "multi-year," neither organization would say how many years it will cover.

"We don't publicly discuss the terms of our agreements with providers," stated UHC Public Relations Manager Spencer Leuning.

How is the capacity issue addressed under this new agreement?

"Medical need, including Mayo Clinic's ability to provide serious or complex care that a patient's contracted health care provider cannot, remains the primary factor for obtaining an appointment. To assure we have availability for Medicare fee-for-service patients and Medicare Advantage patients, we do not accept non-contracted Medicare Advantage patients who don't have immediate medical need," stated Mayo Clinic Spokesman Jay Furst . "This agreement allows us to include UHC Medicare Advantage members in our service to those with complex and serious needs."

In 2021, Mayo Clinic reported providing medical treatment to more than 1.4 million patients from every U.S. state and 139 countries. That is up from 1.3 million patients in 2020.

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Jeff Kiger tracks business action in Rochester and southeastern Minnesota every day in "Heard on the Street." Send tips to jkiger@postbulletin.com or via Twitter to @whereskiger . You can call him at 507-285-7798.