M Health Fairview has warned that over 100,000 patients with commercial health plans from UnitedHealthcare could face being out of network starting January 1, 2026. Recently, some affected patients received notifications from the health system regarding this potential shift, which stems from an ongoing contract dispute between Fairview and UnitedHealthcare. The individuals at risk primarily hold commercial plans offered through their employers.
According to a UnitedHealthcare spokesperson, Fairview is seeking a price increase of more than 23% for these commercial plans. This increase would impose an additional $121 million burden on consumers and employers, particularly impacting those who are self-insured, as they would bear the brunt of these rising health care costs. The spokesperson emphasized that these hikes would exacerbate the challenges families face with already soaring healthcare expenses.
In response to the proposed increase, Fairview contends that the raise would be phased in over three years. The health system defends its position by citing inadequate rate increases over recent years, attributing the need for adjustments to economic pressures such as inflation, workforce shortages, and the lingering effects of the pandemic. Dr. Jaya Kumar, Chief Medical Officer at Fairview Health Services, expressed a desire for collaboration, stating, “We invite UnitedHealthcare to join us in finding a solution that prioritizes patients and the care they deserve.” However, he cautioned that UnitedHealthcare’s current contract demands could compel Fairview to make difficult choices, potentially affecting the range of services provided to patients.
Despite the conflict, both parties have stated their commitment to negotiating in hopes of reaching an agreement by the end of the year. This dispute follows the resolution of a previous contract negotiation concerning Medicare Advantage plans earlier this month, where UnitedHealthcare confirmed that those enrolled in Medicare will continue to have in-network access to Fairview.
David Holt, a healthcare attorney in the Twin Cities, highlighted the broader tensions affecting the healthcare landscape. He noted that impending changes at the federal level, such as adjustments to Affordable Care Act premiums, are contributing to the uncertain atmosphere. Additionally, Minnesota officials have begun scrutinizing certain Medicaid services that are perceived to be at high risk for fraud.
Holt, while advocating for small healthcare providers, acknowledged the difficulties patients face in securing specialized care as they weigh their options. “Small providers, big providers [have] waitlists, especially when we’re talking about specialists,” he remarked, emphasizing the challenges of timely access amid growing demand. “It’s not easy, and a provider does not have a legal obligation to provide a specific timeline for appointments if they’re at capacity.”
