Hospital systems leaving Medicare Advantage networks rarely explain themselves in vague terms. When Providence and Baptist Health each told patients this year that they were parting ways with Medicare Advantage insurers, both organizations pointed to the same two complaints: plans denying and delaying care that should have been approved, and insurers paying too slowly for care already delivered. Those are not a reporter’s summary of the dispute. They are the reasons the health systems put in writing themselves.
Providence’s CEO Names Denials and Delayed Payment
Providence Clinical Network, the group of Providence-affiliated medical practices across Los Angeles, Orange, San Bernardino, Humboldt, Napa, Sonoma and Ventura counties, stopped accepting UnitedHealthcare’s individual Medicare Advantage HMO plans on January 1, 2026. Providence’s hospitals and UnitedHealthcare’s group retiree Medicare Advantage plans were not part of the change. Patients enrolled in individual HMO plans who kept seeing Providence doctors moved out of network at the start of the year.
Providence’s own contract-termination notice to patients confirms those details, and Providence President and CEO Erik Wexler explained the broader decision in a January interview reported by Becker’s Hospital Review, saying commercial Medicare Advantage arrangements have “deteriorated significantly” for health systems in recent years. “If we are not seeing fair performance in how we are paid for the care we provide, and if denials and delays are not within a reasonable sphere of performance, then we are not going to continue working with that commercial payer,” Wexler said. “It’s time for us to reset the way the program works.” Both complaints, denials and delayed payment, are named directly by Providence’s own chief executive, not inferred from the contract dispute.
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Baptist Health’s Notice Cites the Same Two Problems
Baptist Health, the nine-hospital system based in Louisville, Kentucky, has been out of network with UnitedHealthcare’s and Centene’s Wellcare Medicare Advantage plans since January 1, 2026, after contract negotiations broke down. It was not the first insurer Baptist Health cut loose over Medicare Advantage terms. The system went out of network with Humana’s Medicare Advantage plans in September 2023, citing what it described at the time as the identical complaint it later raised against UnitedHealthcare and Wellcare.
In its statement explaining the newer split, Baptist Health said “coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” a line Becker’s Payer Issues reported directly from the health system’s own notice. Baptist Health also told patients the change could raise costs substantially: someone on an individual Medicare Advantage HMO plan who continues seeing a Baptist Health doctor could face “significantly higher” out-of-pocket costs, while patients with certain group PPO coverage may keep paying in-network rates. Baptist Health’s current network-status page shows the dispute has not been resolved, and it is set to widen. Wellcare’s hospital-based services at Baptist Health facilities are scheduled to fall out of network entirely on September 30, 2026.
Federal Reviewers Flagged the Same Pattern Earlier
The complaint is not limited to two health systems, and it did not start with either of them. A 2022 review by the Department of Health and Human Services’ Office of Inspector General found that some Medicare Advantage plans denied prior authorization requests for care that met Medicare’s own coverage rules. Providence and Baptist Health are describing, in their own words, the same pattern federal auditors identified years before either system ended a contract over it. Both systems frame the dispute as one insurers could fix through renegotiation rather than something built permanently into Medicare Advantage, which is why each has said publicly it remains open to new terms.
Contract Fights Outlast the Enrollment Calendar
Both disputes remain open as Medicare’s annual enrollment period approaches. Enrollment runs October 15 through December 7 nationwide, the one stretch each year when most Medicare beneficiaries can switch plans without a special qualifying event. A retiree who signed up for a Providence-network HMO or a Baptist Health-affiliated Wellcare plan before either split should not assume the coverage will include the same doctors once the new plan year starts in January. Neither health system has announced that its dispute has been resolved, and Baptist Health’s own notice states its remaining Wellcare exposure narrows further on September 30, tightening the window before enrollment opens.
This article was produced with the assistance of AI and reviewed by The Financial Wire editorial team.
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David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
