LOUISVILLE, Ky. (WDRB) -- One of the largest health care providers in Kentucky is now off limits to even more seniors who have Medicare Advantage plans from private insurance companies.
As of Jan. 1, Louisville-based Baptist Health System is no longer "in network" for Medicare Advantage plans run by for-profit insurers United Healthcare and WellCare. Baptist had warned patients of the looming cut-off in September, just ahead of the "annual enrollment" period when seniors can change their Medicare plans.
The move adds to Baptist's ongoing Medicare Advantage stalemate with Louisville-based insurer Humana, which began in September.
As of last month, Humana, United Healthcare and WellCare collectively covered 271,328 people in Kentucky and the southern Indiana counties in Baptist's territory through their various Medicare Advantage plans, according to WDRB's analysis of federal data.
Baptist's stalemate with United Healthcare and WellCare is broader than its dispute with Humana. While Humana Medicare Advantage members still have in-network access to Baptist's hospitals, those covered by United Healthcare and WellCare are out-of-network for both Baptist's hospitals and its physician group, the Baptist Health Medical Group.
The change means patients who continue to get services from Baptist could be on the hook for higher out-of-network costs. For certain plans called HMOs, those out-of-network costs are so high, Baptist said, that it canceled appointments after Jan. 1 so that patients wouldn't get stuck with the bill.
Baptist, a nonprofit that operates hospitals, outpatient facilities and doctors offices in Louisville, central and western Kentucky, has criticized the red tape that some insurers impose when covering services under Medicare Advantage plans.
"It is our experience – and the experience of other healthcare providers across the country – that many Medicare Advantage plans routinely deny or delay approval or payment for medical care recommended by a patient's physician," the organization said on its website. "We think the need for medical care should be determined by a patient and his or her doctor, not an insurance company. We are working hard to protect our patients' rights to the care that's medically appropriate for them."
In a report released to bond investors in December, Baptist said "going out of network for certain Medicare Advantage plans" was among its strategies to improve its finances.
The Baptist system posted a slight operating loss on its $4.2 billion in revenue during the year ended Aug. 31, according to the December disclosure.
Minnesota-based United Healthcare, the largest Medicare Advantage insurer in the country, said in a statement that Baptist has made "repeated demands for changes to our contract."
"While we remain open to continued discussions, our focus now is ensuring the people we serve have access to the care they need through either continuity of care or a smooth transition to one of more than 90 hospitals or 14,000 physicians and practitioners remaining in our Medicare Advantage network in Kentucky," United Healthcare spokesperson Spencer Leuning said in an email.
WellCare did not respond to a request for comment Monday.
Medicare Advantage is the privately run version of the federal government's health insurance program for senior citizens and people with disabilities. Seniors can choose to get their benefits through plans administered by insurers instead of traditional Medicare. (Sometimes the choice is made for them through group plans provided by employers who offer retiree insurance benefits.)
Medicare Advantage plans offer benefits such as dental, vision and hearing coverage that are not covered by traditional Medicare. But while nearly all providers accept original Medicare, the Advantage plans typically restrict providers to a network.
For many seniors, it is difficult to figure out which plans will cover the doctors and hospitals they may want to use, said Tricia Neuman, senior vice president at KFF, a nonprofit organization that studies Medicare policy.
"Unfortunately, the burden is on the consumer — on people on Medicare — to sort all this out," Neuman told WDRB News in a November interview.
Baptist notes on its website that, under federal rules, Medicare beneficiaries have one chance to change their plans between Jan. 1 and March 31.
Plans are typically chosen annually in the October-December "open enrollment" period.
