'Leaves Patients Vulnerable': Optum To Go Out Of Network With Some Medicaid, NJ Insurances

On the heels of announcing that it will lay off doctors and close dozens of New Jersey medical offices this month, Optum — a UnitedHealth company — said that early next year, they'll stop participating with certain Medicaid, Medicare, and other insurance plans.

As Patch first reported this month, Optum will lay off 572 doctors, nurses, and medical staff and close dozens of their offices in New Jersey by the end of this month.

The providers and offices that remain open will go out of network with some Medicaid, Medicare, and other plans in January of 2026, the company announced.

An Optum spokesperson said the providers were told of the change around the same time they were notified of the layoffs at the end of last month.

The company gave Patch a statement saying, "[Optum] has made updates to our Medicaid and Medicare payer relationships in New York and New Jersey as part of our ongoing commitment to delivering long-term, affordable care for the communities we serve.... Patients who wish to keep their trusted Optum provider can select from a wide range of in-network plans that can be reviewed here."

The UnitedHealth company will go out of network with the following insurances starting on three dates in January:

Cigna/HealthSpring Medicare Advantage: Effective Jan. 31

AmeriGroup (Wellpoint):

• Medicaid-NJ: Effective Jan. 31
• Medicare Advantage: Effective Jan. 31

All Fidelis plans, including:

• Medicaid-NJ: Effective Jan. 1
• Commercial-NJ: Effective Jan. 1

Horizon:

• Medicare Advantage: Effective Jan. 15
• Medicaid: Effective Jan. 15
• Dual Special Needs (DSNP): Effective Jan. 15

The Advantage plans are typically used by seniors on Medicare to expand their range of providers.

The full list of affected plans is here. Double check to see if your plan is on it.

'Leaves Patients In A Vulnerable State'

Patients were shocked earlier this month to get 30 days' notice that they'd lose their psychologists, pediatricians, and more.

Optum announced that they'd drop all of their behavioral health providers in New Jersey.

Carrie Hodge, a physician's assistant who helped found Dimer Health in North Jersey — a virtual medical practice that takes insurance — said she helped start the company because of situations like with Optum. She called what's happening "disruptive," noting that there could be long-term health effects.

"When access to care like this changes rapidly for people, for both Medicaid and Medicare recipients — some of the most vulnerable — this type of disruption leaves patients in a much more vulnerable state," she said in an interview.

She added that when care is disrupted, "What that leads to is more disease exacerbation, untreated symptoms. That, to me, is the tragedy of all of this. People are going to be left foundering."

A Patch reader agreed in the comments section of a recent Optum story, noting, "We need the behavioral health! I’ve had the same doctor for nearly a decade and my children have been seeing theirs for years. You are leaving some of the most vulnerable people in this city in the dust."

Hodge said that as a breast cancer survivor, she knows the importance of consistent care.

"Optum is closing a lot of their specialty offices, and one of them is behavioral health," she said. "These are people with specialized conditions being managed....When you're dealing with something that difficult, trying to navigate our complex health care environment can be extremely overwhelming and exhausting."

She said that government support of Medicaid and Medicare can impact whether a company takes those insurances, noting that reimbursement rates may be lower than for private insurances, causing companies like Optum to drop the programs.

But Hodge said it doesn't make sense for patients to have to struggle to get health care anywhere, in this day and age.

"We're in a time when technology has evolved," she said. "Access to care shouldn't be an issue anymore. Amazon can get you a package overnight, but we can't get people basic healthcare where they're at."

Read More

• Optum To Restore 2 Pediatricians In One NJ City After Outcry
• Patients React After Optum Closes Dozens Of Medical Offices In NJ
• Major Healthcare Provider Closes Medical Offices In NJ
• Optum To Lay Off 572 Doctors, Others Statewide

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