Allegations of payment delays and denials keep surfacing in Medicare Advantage disputes

With Medicare Advantage plans, beneficiaries opt to receive their government-sponsored benefits through private health insurance companies. That means insurers, not Medicare, create the networks of doctors and hospitals where subscribers can receive care through taxpayer-supported Medicare plans.

UnitedHealthcare, the nation’s largest insurer, told the Star Tribune this week that it presented a contract on Oct. 15 for Fairview to sign, but Fairview declined, the company says. It argues the health system is now using patients as a bargaining chip during Medicare open enrollment, which began earlier this month.

The health system is firing back, saying UnitedHealthcare made false claims by describing a proposed letter of agreement as a contract, without mentioning that it added new conditions at the last minute that hadn’t been agreed upon. Fairview didn’t say what those conditions were, but said they would reduce transparency and “weaken” patient protections.

Fairview says it has been, and remains, willing to sign a one-year agreement for 2026 just for Medicare Advantage patients based solely on previously accepted terms, but UnitedHealthcare has insisted on simultaneous negotiations for a contract for Medicare beneficiaries and commercial/employer coverage.

“UnitedHealthcare is entitled to its own opinion, but not its own set of facts,” Fairview said in a statement.

More broadly, the health system asserted: “What’s happening here is part of a growing national issue: seniors across the country are facing disruptions as large, for-profit insurers walk away from communities or impose practices that delay and deny care.”