Genesis HealthCare System Takes Steps to Protect Local Care as Insurance Denials Increase

ZANESVILLE, OH – According to a press release, Genesis HealthCare System has notified Aetna, UnitedHealthcare, Medical Mutual of Ohio (all three for their Medicare Advantage plans) and CareSource (for both Medicare Advantage and Medicaid) that it will end current contracts on Jan. 1, 2027, unless fair, new terms are reached. The decision follows two years of increasing denials and payment takebacks for care that Genesis doctors determined patients needed and Genesis provided. Commercial employer-sponsored insurance for working families is not affected. This also does not affect any traditional Supplemental Medicare/Medigap plans.

For patients, nothing changes today. Coverage remains the same through Dec. 31, 2026. Patients should keep their appointments, seek care when they need it and come to the emergency department in an emergency.

“This was not our first choice but was our last resort. We had to take this action because we believe the behaviors of these insurance companies are so harmful to patients, doctors and our community’s hospital,” said Matthew Perry, President & Chief Executive Officer of Genesis HealthCare System. “Patients should be able to count on their insurance company to cover the care their doctors determine they need. If they will, we will gladly renew our contracts.

Genesis is contesting 9,000 active denials of coverage for care already provided, resulting in millions of dollars in losses. Genesis believes many of these practices are inconsistent with federal Medicare rules for how care must be covered. Because Genesis does not send patients surprise bills for amounts it believes insurance companies are responsible for paying, those unpaid costs affect Genesis’ ability to continue providing the doctors, nurses, team members and local services the community depends on for high-quality care close to home.

If new agreements are not reached, these plans will be out-of-network at Genesis for non-emergency care beginning Jan. 1, 2027. Emergency care is always covered at an in-network rate, and patients should never hesitate to seek emergency care.

What patients can do:
• Medicare: Medicare’s Annual Enrollment Period runs Oct. 15 through Dec. 7. Genesis will host free community sessions, publish a plain-language guide and answer questions through the Patient Financial Advocate Hotline at 740-454-4335. Genesis cannot recommend or choose a plan for patients, but it will provide clear information and help patients find trusted, unbiased support.
• Medicaid: Patients with Medicaid have the right to change insurance companies. If Genesis is out-of-network with CareSource on Jan. 1, 2027, patients can change their plan by visiting www.ohiomh.com or calling the Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 711).

Genesis promises to patients:
• Genesis will share what it knows when it knows it, in plain language as discussions continue.
• Genesis will not send patients a surprise bill for amounts it believes their insurance company is responsible for paying. To make that promise work, Genesis may need patients’ help during the process, including responding promptly to insurance questions, appeal requests, forms or information needed to protect patients’ coverage and help Genesis pursue payment from insurance companies.
• Genesis will help patients appeal against wrongful insurance denials at no charge.
• Genesis will keep serving the community with compassion, excellence, integrity, teamwork and innovation.

Patients can learn more, get help and stay informed at genesishcs.org/protecting-our-mission or by calling the Patient Financial Advocate Hotline at 740-454-4335.