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Mayo Clinic to Leave Most UnitedHealthcare and Humana Medicare Advantage Networks

Effective January 1, 2026, Mayo Clinic will no longer be an in-network provider for most individual Medicare Advantage plans from UnitedHealthcare and Humana — affecting patients at Mayo facilities in Minnesota, Wisconsin, and Iowa.

• In Minnesota, the number of insurers offering Medicare Advantage with in-network Mayo access will drop from five in 2025 to just two in 2026 — part of a larger trend that has Minnesota experiencing the second-largest drop in available Medicare Advantage plans in the nation.

Johns Hopkins and UnitedHealthcare Officially End Negotiations, Leaving 60,000 Patients Out-of-Network

After eight months of negotiations and five extensions, Johns Hopkins Medicine and UnitedHealthcare ended contract talks without agreement. As of August 25, Johns Hopkins facilities are out-of-network for most UHC members.

• Approximately 60,000 people in Maryland, DC, and Virginia are impacted — patients with employer-sponsored, individual, Medicare Advantage, and Medicaid plans all face higher costs or forced provider changes.
• The stalemate was reportedly not over money — both sides had agreed on financial terms. The dispute centered on contract language about patient care and denials.
• Johns Hopkins stated it would not agree to terms allowing an insurer to "prioritize profits over patients" through "excessive delays or denials" of care.

Read the Banner Article → Read the CBS News Article →

LVHN to Drop UnitedHealthcare Insurance Plans

Lehigh Valley Health Network (LVHN), part of Jefferson Health, announced it will terminate contracts with UnitedHealthcare in 2026 if a new agreement is not reached — citing UHC's failure to pay negotiated rates since 2021, resulting in reimbursement 40% below expected levels.

• Medicare Advantage contract ends January 25, 2026. Commercial insurance contract ends April 25, 2026.

Read the DelcoTimes Article → Read the LVHN Official Update →

'Not Sustainable': OHSU and UnitedHealthcare Near Contract Expiration

Oregon Health & Science University, a premier medical institution, warned patients it may be forced out of network with UnitedHealthcare, citing "administrative burdens" and denial rates that make it impossible to provide sustainable care.

Duke Health Could Drop UnitedHealthcare for 170,000 Patients

Duke Health is in a standoff with UnitedHealthcare that threatens to leave 170,000 North Carolinians without in-network access to their doctors — highlighting that even top-tier academic medical centers are being squeezed by insurer tactics.

M Health Fairview: 125,000 Patients at Risk

M Health Fairview warns that UnitedHealthcare's practices could block 125,000 patients from care — following a trend in UnitedHealth's own home state of providers pushing back against the giant.

Corewell Health vs. UnitedHealthcare: Michigan's Battle

Corewell Health, a massive provider in Michigan, is locked in a dispute with UnitedHealthcare. The friction points are consistent with national trends: insurers paying less while demanding more administrative hurdles that delay patient care.

USA Health Contract Expires: Patients Left in Limbo

In Alabama, the contract between USA Health and UnitedHealthcare officially expired — immediately thrusting patients into "out-of-network" status, facing astronomical bills or loss of care.

TriHealth Dispute: Cincinnati Patients at Risk

TriHealth in Cincinnati warns that thousands could lose coverage. The pattern is undeniable — regional health systems across the entire country are simultaneously reaching a breaking point with UnitedHealthcare's business practices.

LCMC Health: 30,000 New Orleans-Area Patients at Risk

LCMC Health and UnitedHealthcare entered a contract dispute threatening to remove 8 major New Orleans-area hospitals from UHC networks — impacting patients across employer-sponsored and ACA exchange plans.

• 30,000 patients affected. Hospitals include East Jefferson General, Touro Infirmary, University Medical Center, and West Jefferson Medical Center.
• LCMC claims UnitedHealthcare wants to pay well below inflation and far below competitor rates, despite LCMC being the "lowest cost provider across the region."

The "Downcoding" Epidemic: Aetna & Cigna

It isn't just UnitedHealthcare. A new explainer details how Aetna and Cigna are implementing aggressive "downcoding" policies — automatically lowering the severity level of emergency room visits to pay less, regardless of what the doctor actually treated. This is algorithmic wage theft against hospitals.

UnitedHealth's Optum Unit CFO Steps Down

Roger Connor stepped down as CFO of UnitedHealth's Optum unit after less than six months — the latest in a significant period of management reshuffling at UnitedHealth after the company missed earnings targets for the first time in over a decade.

• In the past year, the company has appointed a new group CFO, a new CEO of Optum, and new heads of Optum Rx (pharmacy) and Optum Health (clinics and home-care).

UnitedHealth Marked Up Lifesaving Drugs as Much as 1,000%: FTC

A class-action lawsuit filed in Minnesota accuses UnitedHealthcare, through subsidiaries Optum Rx and Accredo, of significantly marking up specialty drugs — sometimes by thousands of dollars per prescription compared to what the pharmacy actually paid — in violation of ERISA fiduciary duties.

• Alleged markup: dimethyl fumarate (MS drug) — from ~$200 Accredo paid to over $4,000 charged to the patient's plan.
• Alleged markup: lenalidomide (cancer drug) — from ~$300 to over $6,000.
• The lawsuit alleges UHC's PBM (Optum Rx) directs patients to its own affiliated specialty pharmacy (Accredo), creating a closed system for inflated pricing, while hiding the markups through complex contracts and lack of transparency.

UnitedHealth Accused of Overcharging for Drugs in Class Action

A federal class-action filed in Minnesota accuses UnitedHealth Group and Optum Rx of breaching ERISA fiduciary duties by orchestrating a scheme to massively overcharge employer health plans for specialty medications dispensed through affiliated pharmacy Accredo.

• Dimethyl fumarate (MS drug): allegedly acquired for ~$200, billed to the plan at over $4,000.
• Lenalidomide (cancer drug): allegedly acquired for ~$300, billed to the plan at over $6,000.
• Note: Accredo Specialty Pharmacy is owned by Cigna; the lawsuit alleges it collaborates with UHG's Optum Rx in this pricing scheme.

Knowing When and How to Fight Back: Protecting Independent Community Pharmacies from Overbearing PBMs

The top 3 PBMs — CVS Caremark, Express Scripts/Cigna, and Optum Rx/UnitedHealth — control approximately 80% of the prescription drug market and hold immense power over independent community pharmacies through network participation, reimbursement rates, drug formularies, and audit processes.

• PBM tactics include: Spread Pricing (charging health plans more than they pay pharmacies), reimbursements below drug acquisition cost, retroactive Direct and Indirect Remuneration (DIR) fees, patient steering, restrictive network contracts, and burdensome audits.
• Independent pharmacies often face a "take it or leave it" scenario with PBM contracts due to market dominance.
• Legal avenues include state PBM laws, state insurance departments, attorneys general, the ongoing FTC investigation, and arbitration or litigation for contract breaches.