Important information for patients with UnitedHealthcare health insurance plans. 

Saint Joseph Health System has been working hard to reach a fair agreement with UnitedHealthcare that more appropriately covers the true cost of the care we provide to patients.

Unfortunately, UnitedHealthcare has forced Saint Joseph Health System out of its network, effective July 1, 2024. This impacts patients who are covered by UnitedHealthcare commercial (employer-sponsored), Medicare Advantage, and Medicaid plans. UnitedHealthcare has disrupted your access to Saint Joseph Health System Hospital, facilities, and physicians. 

Why did UnitedHealthcare force Saint Joseph Health System out-of-network?

The payment we receive from UnitedHealthcare does not appropriately cover the true cost of the care we provide. We rely on fair reimbursement so we can sustain the high-quality care people depend on and need, but UnitedHealthcare frequently denies, delays, and underpays our hospitals and providers. We are asking for fair reimbursement, which UnitedHealthcare continues to deny us.

UnitedHealthcare has misrepresented our request for fair payment as a not-for-profit health system. In truth, we are seeking a multi-year agreement with single-digit increases on average, so that we can continue to invest in the medical innovations, technologies, and programs that people rely on. UnitedHealthcare claims to be concerned about lowering costs for members, but it is growing its own bottom line by trying to pit patients and providers against each other. It rakes in billions by choosing to increase member’s monthly out of pocket costs, deny claims and underpay health systems like ours and others across the country. 

Continuity of Care

Some patients, including those who are pregnant or undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. Unfortunately, Saint Joseph Health System cannot qualify you under UnitedHealthcare's process.

• UnitedHealthcare requires you to call the number on the back of your insurance card to see if you qualify.
• UnitedHealthcare will provide additional instruction on how to enroll based on your health plan.
• If UnitedHealthcare denies your Continuity of Care request and you are currently undergoing treatment at Saint Joseph Health System and are enrolled in a Medicare Advantage benefit plan, you can file a complaint with the Center for Medicare and Medicaid Services following the instructions at www.medicare.gov/my/medicare-complaint  or calling 800-985-3059. 
• If UnitedHealthcare denies your Continuity of Care request and you have insurance through your employer, contact your HR or benefits manager.
• If UnitedHealthcare approves your Continuity of Care request, it must permit continued in-network access to your current health care provider for a certain period of time.
  
  • If UnitedHealthcare denies your Continuity of Care request and you have insurance through your employer, contact your HR or benefits manager.
  • If UnitedHealthcare approves your Continuity of Care request, it must permit continued in-network access to your current health care provider for a certain period of time.

Your provider’s office can support in filling out the continuity of care form from UnitedHealthcare.

We know how important it is for you and your family to continue receiving care from the trusted doctors, nurses, and staff at Saint Joseph Health System. We will not give up trying to reach a fair agreement with UnitedHealthcare that brings us back in-network.

If you do not find the answers to your negotiation-related questions on this site, please contact us directly via this website through our contact us page or call our patient line at 574-404-8111. This website will be updated as our negotiations continue, so please check back for the most up-to-date information.

Frequently Asked Questions

Regrettably, UnitedHealthcare has forced Saint Joseph Health System Health hospitals, facilities, and providers out of network for patients covered by UnitedHealthcare commercial (employer-sponsored), Medicare Advantage, and Medicaid health plans, as of July 1, 2024. Below, we’ve provided in-depth information to help our patients understand how the disruption caused by UnitedHealthcare may impact them:

Q: What is happening?

Saint Joseph Health System has been working diligently to secure a new agreement with UnitedHealthcare that more appropriately covers the true cost of the care we provide to patients with UnitedHealthcare commercial (employer-sponsored), Medicare Advantage, and Medicaid plans.

At this time, our existing agreement has expired. UnitedHealthcare has made the decision to force Saint Joseph Health System out of its network as of July 1, 2024. This means impacted patients may experience disruption when trying to access their trusted Saint Joseph Health System hospital or health care provider. UnitedHealthcare may also force you to pay more out-of-pocket for the health care services you receive through Saint Joseph Health System moving forward. 

Q: Who is affected by the negotiation?

Patients who receive health insurance coverage through UnitedHealthcare commercial (employer-sponsored), Medicare Advantage, and Medicaid plans are impacted. UnitedHealthcare no longer includes Saint Joseph Health System in your provider network, effective July 1, 2024. 

Q: Which providers and facilities are impacted? 

Saint Joseph Health System hospitals, facilities, and employed providers are impacted by these contract negotiations.  

• Saint Joseph Health System – Mishawaka Medical Center
• Saint Joseph Health System – Plymouth Medical Center
• Saint Joseph Medical Group

Q: Can I continue to see my Saint Joseph Health System health care provider?

Some patients, including those who are pregnant or undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. Unfortunately, Saint Joseph Health System cannot qualify you under UnitedHealthcare's process.

• UnitedHealthcare requires you to call the number on the back of your insurance card to see if you qualify.
• UnitedHealthcare will provide additional instruction on how to enroll based on your health plan.
• If UnitedHealthcare denies your Continuity of Care request and you are currently undergoing treatment at Saint Joseph Health System and are enrolled in a Medicare Advantage benefit plan, you can file a complaint with the Center for Medicare and Medicaid Services by calling 800-985-3059.
• If UnitedHealthcare denies your Continuity of Care request and you have insurance through your employer, contact your HR or benefits manager.
• If UnitedHealthcare approves your Continuity of Care request, it must permit continued in-network access to your current health care provider for a certain period of time.

Q: What is Saint Joseph Health System doing to reinstate its in-network status?

We will not give up trying to reach a fair agreement with UnitedHealthcare. We know how important it is for you and your family to continue receiving care from the trusted doctors, nurses, and staff at Saint Joseph Health System. Your voice can make a difference. Call UnitedHealthcare and tell them to focus on you, not just their own profits.

Q: If I’m not covered by a UnitedHealthcare health plan, does this impact my insurance too?

No, our out-of-network status only affects patients covered by a UnitedHealthcare health plan.  

Q: What if I’m pregnant or receiving treatment for an ongoing condition at Saint Joseph Health System?

Some patients, including those who are pregnant or undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. Unfortunately, Saint Joseph Health System cannot qualify you under UnitedHealthcare's process.

• UnitedHealthcare requires you to call the number on the back of your insurance card to see if you qualify.
• UnitedHealthcare will provide additional instruction on how to enroll based on your health plan.
• If UnitedHealthcare denies your Continuity of Care request and you are currently undergoing treatment at Saint Joseph Health System and are enrolled in a Medicare Advantage benefit plan, you can file a complaint with the Center for Medicare and Medicaid Services by calling 800-985-3059.
• If UnitedHealthcare denies your Continuity of Care request and you have insurance through your employer, contact your HR or benefits manager.
• If UnitedHealthcare approves your Continuity of Care request, it must permit continued in-network access to your current health care provider for a certain period of time.

Your provider’s office can support in filling out the continuity of care form from UnitedHealthcare.

Q: What if I’m in the hospital on/after July 1, 2024?

If you are already admitted to the hospital prior to July 1, 2024, you will be covered at in-network rates through the end of your inpatient stay.

Q: What if I have an upcoming procedure at Saint Joseph Health System on/after July 1, 2024?

We understand some patients may have appointments scheduled on or after July 1, 2024. If this is the case, you should call UnitedHealthcare at the number on the back of your health insurance care to determine whether they will cover your procedure through Continuity of Care provisions. 

Please contact your provider’s office immediately for support in filling out the continuity of care form from UnitedHealthcare, or re-scheduling your procedure.

Q: What if I have a medical emergency on/after July 1, 2024?

You should always seek emergency care if you believe you are experiencing a medical emergency at the closest location to you. Regardless of our status with UnitedHealthcare, your care will be considered in-network until you are stabilized. 

Q: If my care is impacted, what should I do?

• Never delay care. You will always have in-network access to our emergency department. Regardless of our network status with UnitedHealthcare, you should always visit the closest emergency department if you experience a medical emergency.
• Apply for continuity of care immediately. Some patients, including those who are pregnant or undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. Unfortunately, Saint Joseph Health System cannot qualify you under UnitedHealthcare's process.
  
  • UnitedHealthcare requires you to call the number on the back of your insurance card to see if you qualify.
  • UnitedHealthcare will provide additional instruction on how to enroll based on your health plan.
  • If UnitedHealthcare denies your Continuity of Care request and you are currently undergoing treatment at Saint Joseph Health System and are enrolled in a Medicare Advantage benefit plan, you can file a complaint with the Center for Medicare and Medicaid Services by calling 800-985-3059.
  • If UnitedHealthcare denies your Continuity of Care request and you have insurance through your employer, contact your HR or benefits manager.
  • If UnitedHealthcare approves your Continuity of Care request, it must permit continued in-network access to your current health care provider for a certain period of time.
• Call the number on the back of your insurance card and urge UnitedHealthcare to keep your in-network access to Saint Joseph Health System and its doctors.
• If you receive insurance through your employer, ask about other health plans that include Saint Joseph Health System. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers.  
• If you have Medicare Advantage or bought a UnitedHealthcare plan from the ACA marketplace (also known as the Health Insurance Exchange), contact your health insurance agent/broker for options to switch plans. We work with many other health plans that will give you in-network access to Saint Joseph Health System.   
• If you have UnitedHealthcare Medicaid, you may be able to choose other health care coverage that allows you to access Saint Joseph Health System. Visit www.fssabenefits.in.gov or call 1-800-403-0864 to see if you can change your plan. 

Q: What if I have more questions?

Call us at 574-404-8111 to speak with someone directly or visit sjmed.com/uhc.

What You Can Do

• Never delay care. You will always have in-network access to our emergency department. Regardless of our network status with UnitedHealthcare, you should always visit the closest emergency department if you experience a medical emergency.
• Apply for continuity of care immediately.Some patients, including those who are pregnant or undergoing active treatment for a chronic condition, may qualify for extended in-network access through UnitedHealthcare's continuity of care program. Unfortunately, Saint Joseph Health System cannot qualify you under UnitedHealthcare's process.
  
  • UnitedHealthcare requires you to call the number on the back of your insurance card to see if you qualify.
• UnitedHealthcare will provide additional instruction on how to enroll based on your health plan. 
• If UnitedHealthcare denies your Continuity of Care request and you are currently undergoing treatment at Saint Joseph Health System and are enrolled in a Medicare Advantage benefit plan, you can file a complaint with the Center for Medicare and Medicaid Services by following these instructions or calling 800-985-3059.
• Call the number on the back of your insurance card and urge UnitedHealthcare to keep your in-network access to Saint Joseph Health System and its doctors.
• If you receive insurance through your employer, ask about other health plans that include Saint Joseph Health System. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers.  
• If you have Medicare Advantage or bought a UnitedHealthcare plan from the ACA marketplace (also known as the Health Insurance Exchange), contact your health insurance agent/broker for options to switch plans. We work with many other health plans that will give you in-network access to Saint Joseph Health System.   
• If you have UnitedHealthcare Medicaid, you may be able to choose other health care coverage that allows you to access Saint Joseph Health System. Visit www.fssabenefits.in.gov or call 1-800-403-0864 to see if you can change your plan. 

Saint Joseph Health System is in-network with the following plans for the full 2024-2025 benefit year:

Accepted Insurance Plans

We believe Health Comes First  

We know how important it is for you and your family to receive care from the trusted doctors, nurses and staff at Saint Joseph Health System. As a not-for-profit, local care provider, we work tirelessly to care for our patients and communities. We also continue to reduce costs and implement efficiencies to ensure we can continue providing top-quality care to our patients. We are working hard to reach a fair agreement with UnitedHealthcare, but we need them to do the same—and put patients first. Our request to UnitedHealthcare is simple: to be paid fairly and in line with other providers in our market. We cannot maintain access to the care and services patients depend on and need without fair agreements from commercial health insurers who reimburse us for the cost of care.    

Find out how Saint Joseph Health System invests in our community. Health insurers, including UnitedHealthcare, are posting record-breaking profits for shareholders, while we are expected to cover gaps. UnitedHealthGroup, the parent company of UnitedHealthcare, made more than $22 billion in 2023 alone. Saint Joseph Health System cannot continue to do more with less. To learn more, visit Health Comes First.