Lee Health and UnitedHealthcare Split Leaves 50,000 Southwest Florida Patients Facing Out-of-Network Care as Medicare Enrollment Opens

Roughly 50,000 Southwest Florida patients with UnitedHealthcare coverage are on track to lose in-network access to Lee Health's hospitals and doctors on Jan. 1, 2027, and with Medicare open enrollment starting Thursday, Oct. 15, neither side is signaling a deal. Lee Health, the dominant hospital system in Lee County, says the insurer now owes it $150 million in unpaid and underpaid claims, up from $100 million in August. UnitedHealthcare says the health system is using patients as leverage.

The split, first announced Aug. 26, ends both of Lee Health's participation agreements with UnitedHealthcare: the hospital contract and the separate contract covering its physician practices. Both run through Dec. 31, 2026. Unless a late agreement is reached, Lee Health hospitals and physicians will be out of network starting Jan. 1 for UnitedHealthcare employer-based, individual and Medicare Advantage plans, according to WINK News. Medicare Supplement, or Medigap, policies sold through UnitedHealthcare or AARP are not affected.

Lee Health's case: denials and $150 million

Lee Health has said the two organizations have "fundamentally different priorities," contrasting its nonprofit, community-focused mission with a for-profit insurer answerable to shareholders, according to Becker's. The system has pointed to UnitedHealthcare's prior authorization, review and denial processes as the core problem.

Dr. Nariman Heshmati, chief clinical officer for Lee Physician Group, told WINK Investigates that the insurer accounts for an outsized share of the system's denials. "A third of our denials for medical necessity of all our payers comes from United, and here's the thing: the majority of them are overturned on appeal, so they're unnecessary delays in patient care," Heshmati said in a report that aired Oct. 12.

He said the amount Lee Health says it is owed has grown since his last interview with the station on Aug. 27. "Last time I sat down with WINK, we said they owed us $100 million... Well, they now owe us $150 million," he said. Heshmati rejected the idea that the termination is a bid for higher rates. "This isn't a negotiating tactic," he said. "We're asking to be paid for the services we've done." The dollar figures are Lee Health's claims and have not been independently verified.

UnitedHealthcare's response

UnitedHealthcare has disputed Lee Health's account from the start. When the notice went out in August, the insurer said Lee Health had "unexpectedly issued a notice to end our network relationship" without prior discussions and cited problems that had not previously been raised with it, according to WINK News.

In a statement for WINK's October report, a UnitedHealthcare spokesperson tied the dispute to a separate product. "We believe Lee Health's actions are linked to the health system's out-of-network status for our Individual Family Plan (IFP) and that it is now using patients enrolled in our Medicare Advantage and commercial plans as leverage over something that isn't relevant to them," the spokesperson said. The insurer said it remains committed to good-faith discussions and asked Lee Health to return to the negotiating table.

UnitedHealthcare has also launched a frequently asked questions page for affected members at uhc.com/leehealth, covering which plans are affected, continuity of care, emergency care, Medicare Supplement plans and group retiree plans, WINK News reported Oct. 8.

A new CEO inherits the dispute

The standoff lands on the desk of Ben Spence, who became Lee Health's chief executive on Oct. 1. He succeeds Dr. Larry Antonucci, who led the system through regional expansion, the COVID-19 pandemic and its conversion to a private nonprofit, according to WINK News.

Patients weigh their options

Because Lee Health operates the county's single large hospital network, the fallout reaches well beyond a typical insurer dispute. Camilita Aldridge, director of programs and planning for SHINE, the state's free Medicare counseling program, told WINK that the geographic impact is unlike anything she has seen in 12 years in the role, reaching parts of Collier, Hendry, Glades and DeSoto counties as well. "That creates a new challenge we haven't seen before," she said.

Some patients are making drastic choices. Cape Coral residents Robert Sutton, a pancreatic cancer survivor, and Angela Bayless, who has had nine major surgeries in nine years, told WINK they face potential out-of-pocket increases of $20,000 to $30,000 and have decided to sell their home and move. Andrea McMahon, whose husband Bill is a 9/11 first responder with severe respiratory problems, put the question many families are asking: "Where are we supposed to go?"

Other Southwest Florida network changes for 2027

Lee Health is not the only regional system in a standoff heading into 2027. Here is where the major disputes stand, based on reporting by WINK News and WFTV:

Sarasota Memorial said that "changes to key provisions are making our continued partnership with UnitedHealthcare unsustainable," according to WINK. AdventHealth, which has a large presence in Charlotte County, says its current agreement runs through Dec. 31 and that it is negotiating to prevent interruptions in care, WFTV reported.

What UnitedHealthcare members can do now

Lee Health and UnitedHealthcare guidance points to several steps for patients:

• Keep scheduled appointments, tests and procedures through the end of 2026, when Lee Health remains in network.
• Ask about continuity of care. Some patients, including those who are pregnant or in complex or critical care for a chronic illness that continues past Dec. 31, may qualify for in-network rates for a limited time. Call the number on the back of the insurance card to apply.
• Check whether a plan offers out-of-network benefits, which may allow continued Lee Health care at higher cost.
• Remember that federal law requires emergency care to be covered regardless of network status.

For people on Medicare, the annual enrollment period runs Oct. 15 through Dec. 7, and changes made during that window take effect Jan. 1. Free, unbiased help comparing plans is available through SHINE (Serving Health Insurance Needs of Elders) by calling the Elder Helpline at 1-800-963-5337. Lee Health patients with questions can call 239-320-1234 or visit leehealth.org/unitedhealthcare.

What's next

The contracts expire at the end of December, leaving about 11 weeks for a settlement. Medicare beneficiaries must make their open enrollment choices by Dec. 7, before the deadline for a deal, though Medicare Advantage enrollees also get a separate window from Jan. 1 to March 31 to change Medicare Advantage plans or return to Original Medicare. Until Lee Health and UnitedHealthcare announce an agreement, patients covered by the insurer's Medicare Advantage, employer and individual plans should plan for Lee Health being out of network on Jan. 1.