Network Fights: How Agents Should Handle Hospital Contract Disputes During AEP
Every fall, a hospital and a carrier go public with a contract fight, and your phone lights up. Clients want to know if they're losing their doctors. The honest answer is usually "nobody knows yet," and your job is to make that okay.
This year's example: Sarasota
As reported by the Sarasota Herald-Tribune, about 33,000 UnitedHealthcare MA members who use Sarasota Memorial and First Physicians Group go out of network on Jan 1 unless a new contract is signed by Dec 31. Original Medicare and Medigap members aren't affected.
That deadline lands after AEP ends on Dec 7. Clients have to choose a plan before they know how the fight ends.
A network change is not a plan termination
This is the part agents get wrong. When a plan terminates or leaves a service area, that generally triggers a federal guaranteed issue right to Medigap. When a hospital leaves a plan's network, the plan still exists. A network change alone usually is not a termination, so it usually doesn't create that same GI right.
Before you tell a client "you can get a supplement with no health questions," check. If there's no GI right and they're outside a guaranteed access state, they're facing underwriting. Our Med Supp underwriting field guide covers what that looks like. And Justin's recent piece on the difference between a plan ending and a hospital leaving goes deeper.
How to handle the call
Don't predict the outcome. You don't know if they'll sign. Say so.
Show both paths now. Path one: a plan that includes the hospital the client cares about. Path two: Original Medicare with Medigap and a Part D plan, if they can qualify. Lay out costs side by side.
Check GI rights before promising anything. Confirm whether the client has an actual termination notice, lives in a guaranteed access state, or will face health questions.
Ask what matters most. Is it one specialist? The hospital? Cost? That answer drives the plan, not the headline.
Document and follow up. Note the Dec 31 date and call back when the contract news breaks.
Get the free Objection Manual
"I'll just wait and see" is the objection that costs clients the most in a network fight. Brock puts out tons of resources like these, and the Objection Manual gives you language for exactly these conversations. Download the free Objection Manual.
Related reading:
FAQ
Does a hospital leaving my client's MA network give them guaranteed issue Medigap rights?
Usually not. A network change alone generally isn't a plan termination. Check the client's situation and state before promising no health questions.
Who is affected by the Sarasota Memorial and UnitedHealthcare dispute?
As reported by the Herald-Tribune, about 33,000 UnitedHealthcare MA members who use Sarasota Memorial and First Physicians Group, unless a contract is signed by Dec 31. Original Medicare and Medigap members aren't affected.
Should clients wait to see if the contract gets signed?
AEP ends Dec 7, before the Dec 31 deadline. Show both paths now so the client can choose with what's known.
