Three years ago, Sarasota Memorial Health Care Systemand First Physicians Group made significant concessions to remain in UnitedHealthcare’s Medicare Advantage network.
We did so for one reason: to protect our senior patients’ access to high-quality care.
In return, we asked for industry-standard protections against restrictive insurance practices that can delay, deny or complicate medically necessary care.
Now, as that agreement approaches its Dec. 31 expiration, UnitedHealthcare wants to materially weaken those protections and reduce reimbursement – below what it currently pays us and below Original Medicare.
Who should decide medical care?
Let me be clear:
This is not simply a disagreement over reimbursement.
What’s at stake is a fundamental question every Medicare beneficiary
should consider: Who should decide what medical care a patient receives?
I believe those decisions should be based on medical necessity and the judgment of trusted physicians, not an insurer’s financial priorities, restrictive policies or growing reliance on artificial intelligence to guide coverage decisions.
Under Original Medicare, physicians can provide medically necessary care without the extensive prior authorization requirements common in Medicare Advantage plans.
Prior authorization is intended to prevent unnecessary care, but when insurers use it to delay needed treatment and then challenge payment for necessary care, patients and physicians pay the price.
Multiple independent reports reveal UnitedHealthcare has the highest prior authorization denial rates among major Medicare Advantage insurers.
Its aggressive practices and algorithms create unnecessary barriers to care, leaving patients and physicians caught in the middle while helping the company protect its multi-billion-dollar bottom line.
For example, a recent analysis from the Kaiser Family Foundation (KFF) found UnitedHealth Group had the highest standard prior authorization denial rate among six major Medicare Advantage insurers in 2025 – 17%, compared with 5% for the lowest.
Meanwhile, KFF’s review of data from the Centers for Medicare & Medicaid Services shows Medicare Advantage insurers, on average, overturn 80% of prior authorization denials when appealed.
Creating needless obstacles
That is not improving health care.
It is creating unnecessary obstacles between patients and their physicians that drive up administrative costs and delay vital care.
UnitedHealth Group now ranks as the third-largest company in America and the fourth-largest in the world.
It generates nearly $448 billion in annual revenue and more than $12 billion in profits, according to Fortune's 2026 rankings.
In this year’s financial filings, UnitedHealth credited a $2.3 billion year-over-year increase in operating earnings to benefit changes, pricing discipline and cost management, while expanding investments in artificial intelligence and other technologies impacting claim decisions.
At the same time, it demands Sarasota Memorial and other health systems accept terms and conditions that fail to recognize the rising cost of quality, patient-centered care.
We're speaking up for patients
SMH is not alone in raising these concerns.
Becker's Hospital Review has tracked dozens of health systems dropping or narrowing Medicare Advantage participation in 2026, including the Mayo Clinic and Johns Hopkins.
In Florida, Lee Health and Advent Health recently announced plans to leave UnitedHealthcare's Medicare Advantage network at year's end; meanwhile, other major systems, including the University of Miami Health System and BayCare, also faced difficult negotiations with the insurer.
These are not decisions health systems make lightly.
Neither do we.
Our patients have built trusted relationships with their physicians.
They have relied on Sarasota Memorial through cancer treatments, heart procedures, surgeries and countless critical moments.
We do not want to disrupt those relationships.
That is precisely why we are speaking up now.
Our current agreement with UnitedHealthcare remains in effect through Dec. 31.
By alerting patients during Medicare Open Enrollment, which runs through Dec. 7, we are giving them time to explore their options and make informed coverage decisions for 2027.
We encourage all Medicare beneficiaries to visit www.smh.com/medicare for a list of plans accepted by both Sarasota Memorial and First Physicians Group.
You may also wish to consider Original Medicare and standard Medicare Supplement plans, which we always accept and typically do not have the same provider network restrictions as Medicare Advantage plans.
We fully expect to be out of UnitedHealthcare’s Medicare Advantage network Jan. 1, and patients should make their coverage decisions accordingly.
While the door remains open to further discussions, the responsibility rests with UnitedHealthcare to propose terms that fairly reimburse our physicians and hospitals and protect patients from unnecessary barriers to care.
We will keep our community informed at www.smh.com/united.
Our goal is not to win a contract dispute.
It is to protect something far more important: our patients' access to timely, high-quality care and the physicians and caregivers they trust. David Verinder is the CEO of the Sarasota Memorial Health Care System.
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This article originally appeared on Sarasota Herald-Tribune: Sarasota Memorial won't back down to Big Insurance | Opinion
