LOUISVILLE, Ky. (WDRB) -- Louisville-based Baptist Health System faces a second financial dispute with a major insurer that could limit access to Baptist hospitals and doctors for certain Medicare patients.
United Healthcare, the country's largest insurer, told its Louisville-area Medicare Advantage members that its contract with Baptist will expire Jan. 1, and that they should look for new healthcare providers to avoid paying higher "out-of-network" costs for care at Baptist.
United Healthcare is "working hard" to keep Baptist in its network, the insurer said in the Sept. 28 letter, a copy of which was obtained by WDRB News.
Baptist's fight with United Healthcare comes as the large nonprofit health system continues to remain at odds with insurer Humana Inc., which is also headquartered in Louisville.
Humana Medicare Advantage plans have not included the Baptist Health Medical Group — Baptist's physician practices — in their network since a contract between the two companies expired Sept. 22.
A spokeswoman for Baptist declined to comment on the United Healthcare dispute, saying the health system plans to release more information next week. She was unable to say how many patients may be caught up in the dispute.
"Our top priority is to renew our relationship with Baptist Health and ensure continued, uninterrupted access to the health system for people enrolled in our Medicare Advantage and Group Retiree plans," United Healthcare said in an emailed statement. "We are committed to continued good-faith negotiation and utilizing the nearly three months remaining on our contract to reach a new agreement."
Medicare Advantage is the privately managed version of the federal government's healthcare program for seniors. While traditional Medicare can be used at most any doctor or hospital, seniors can choose to have a private insurer like Humana or United Healthcare provide their Medicare benefits.
The Advantage plans provide extra benefits like dental, hearing and vision coverage and sometimes even gym memberships or cash for groceries. But in exchange, seniors agree to be subject to restrictions like provider networks or prior authorizations.
The situation with Baptist Health shows the disruption that seniors risk when they chose the Advantage plans, said Wendell Potter, a former executive at Humana and insurer Cigna.
"People who are considering enrolling in a Medicare Advantage plan need to understand that the doctor who might be listed as being 'in network' today might not be tomorrow. And the same can be said about hospitals. It's 'buyer beware,'" said Potter, who runs the Center for Health and Democracy, a nonprofit that champions health reform.
The Humana dispute with Baptist's physician group has left some patients delaying appointments or seeking new providers, even if they've seen the same primary care or specialist for years. The Baptist group consists of 1,100 physicians and other clinicians, in about 75 specialties, across Kentucky and southern Indiana.
"We understand that changing healthcare providers can be difficult. Humana maintains a large network of highly rated providers in Kentucky," Humana spokesman Mark Taylor said in a statement.
He added that Humana members may be eligible for continued coverage at in-network rates during a transition period to a new provider.
The Humana rift with Baptist also includes Humana's employer-sponsored commercial plans, though Humana is phasing out commercial plans from its business altogether.
The United Healthcare dispute is broader, encompassing Baptist's hospitals in addition to its physician group. But it does not involve United Healthcare's commercial members — only those on Medicare Advantage plans.
Potter, the health reform advocate, said one pitfall of Medicare Advantage is that the plans are not required to tell consumers how long they are contracted with various providers, so the frequent disputes can catch patients off guard.
"There's a lot a whole lot that these companies consider proprietary that they absolutely will not disclose even to the federal government, which is outrageous," Potter said. "And you just simply don't know."
