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Important Update: Effective January 26, LVHN Out of Network for UnitedHealthcare Medicare Advantage Plan

January 21, 2026

Message for UnitedHealthcare Medicare Advantage Members

As we first shared with you in November, Lehigh Valley Health Network (LVHN) has been working to achieve a fair agreement with UnitedHealthcare (United) to continue to remain an in-network provider for the patients, like you, we are privileged to serve.

Despite our best efforts, United has refused to engage fairly with LVHN and to operate in accordance with the rates and expectations that were originally agreed upon.

While we have worked tirelessly to reach a resolution in our ongoing legal dispute with United, we have been unable to reach an agreement.

As of January 26, 2026, LVHN will be out of network for United Healthcare Medicare Advantage, which means that patients currently covered by UnitedHealthcare Medicare Advantage products will no longer be able to get care in network at LVHN. You will have the option to continue care at LVHN on an out of network basis (if your plan provides out of network benefits), or by paying out of pocket.

As an LVHN patient, your health and well-being are our priority, and we continue to work toward achieving a fair agreement with United to avoid disrupting your care. While we continue to engage in good faith, we wanted to make you aware of a few important things about your care should LVHN and United not renew their agreement for Medicare Advantage members:

  • Continuity of Care: If you are receiving care for a serious condition and wish to continue receiving care with LVHN, you may be able to do so through Continuity of Care programs. Call the number on your United health plan ID card for assistance with Continuity of Care.
  • Access to the emergency room: Patients will always have in-network access to our emergency rooms, regardless of contract status with United. If you experience an emergency, you should always visit the nearest emergency room.
  • Other options for care: Jefferson Health clinicians remain in-network and may be a good option for United Medicare Advantage patients. Talk with your caregiver if you are interested in continuing your care through a Jefferson clinician.
  • Out of Network benefits: Some United members can use their out of network benefits to continue to access our hospitals and health care clinicians on an out of network basis. Contact United Healthcare to understand your plan benefits.

If you have an upcoming appointment with an LVHN clinician, we can help you cancel or reschedule with another LVHN or Jefferson Health clinician who participates in your updated insurance plan.

We are disappointed that United has put LVHN and our patients in this difficult position. Our goal remains to establish a fair relationship with United that will enable LVHN to continue providing the highest-quality care

Frequently Asked Questions (FAQs)

You may have the option to continue your care at LVHN on an out-of-network basis; however, you may now be responsible for a higher percentage of the costs (if your plan offers out-of-network benefits) or for the full cost of care (paying out of pocket).

If you have a PPO plan with United, you have out-of-network benefits and can continue to see your doctor(s) at LVHN, but your cost sharing (copays, coinsurance, deductible) and out-of-pocket maximum will all be higher. This means that you will pay more out of pocket for physician visits and other services. You will need to contact United to understand how much higher your costs will be.

If you have an HMO plan with United, you will not have out-of-network benefits. You may elect to continue seeing your doctor(s) at LVHN, but you will now be responsible for the full cost of services.

If you have an HMO-POS (point of service) plan with United, you will have some limited out-of-network coverage. The benefits may be capped at a certain amount or may only be available for certain services. You will need to contact United for more information on the benefits for your specific plan.

Yes, in the event of an emergency, United is required by federal law to cover ambulance services. United can tell you what your cost sharing will be for out-of-network ambulance services.

Yes, United is required by federal law to cover all emergently needed services, which will include visits to LVHN emergency departments. United can tell you what your cost sharing will be for out-of-network emergency services.

United is required by federal law to cover inpatient stays from an emergency admission until you are stable enough to be transferred. At that time, United may – but is not obligated – to continue covering your stay at LVHN. LVHN will request prior approval for payment from United in these situations. We will make every effort to avoid transferring United Medicare Advantage patients to sites of care, but the final decision regarding payment rests with United.

Urgent care visits may be covered. United is required under federal law to cover urgently needed services only when there is no in-network alternative available. If you need to be seen urgently, and your travel time to an LVHN ExpressCARE or JeffExpress Urgent Care is roughly the same as another urgent care facility that is in network, a visit to an LVHN ExpressCARE or JeffExpress Urgent Care might not be covered. United can provide more information regarding coverage in these circumstances and in-network alternatives.

You will not need any preapproval for emergency services. If you were admitted from the emergency room and have been stabilized, LVHN will request prior approval from United to avoid unnecessary transfers.

If you have a PPO or HMO-POS plan, you may need preapproval for certain services, including elective procedures. You should not need to obtain prior approval or a referral for office visits (including primary care and specialist visits), but you should confirm this with United. These visits may or may not be covered, depending on your plan.

If you have an HMO plan, you will not have out-of-network benefits and you will be responsible for the full cost of coverage, so United will not grant prior approval.

Medicare Coordination of Benefits rules will apply, and United may still pay. Contact United for more information.

You may be able to continue receiving care under a rule called “continuity of care” (CoC). Under CoC rules, United is required to continue covering ongoing, active treatments at in-network cost-sharing levels for up to 90 days when you have a serious or complex medical condition(s). These conditions include, but are not limited to, pregnancy and active cancer treatment. Under CoC, United is only required to pay for treatment related to your specific condition(s) and not for unrelated care (such as routine exams and elective procedures). United requires you to apply and be approved for CoC. Call the number on your health plan ID card for assistance with this application.

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