LOUISVILLE, Ky. (WDRB) — Louisville-based insurance giant Humana Inc. is at odds with one of the community’s biggest healthcare providers, Baptist Health.
Humana-covered patients may lose in-network access to about 1,650 Baptist providers after Sept. 22, the nonprofit healthcare system told patients recently in a letter obtained by WDRB News.
The dispute concerns only Baptist Health Medical Group physicians and advanced practice clinicians — not Baptist’s hospitals — and primarily affects seniors who get their Medicare benefits via Humana Medicare Advantage plans.
Humana and Baptist are also at odds over rates paid for Humana’s commercial members, but Humana is phasing out employer-based insurance, so those members will be migrating to new coverage regardless.
“Our community relies on us to provide high-quality healthcare services,” Baptist spokeswoman Kit Fullenlove said in a statement. “We are working hard to ensure there is no disruption in medical care for our patients. Baptist hopes to reach a new arrangement with Humana prior to September 22 for all insurance plan members.”
Humana also said it hopes to reach a deal with Baptist before the Sept. 22 deadline.
"We understand that changes regarding one’s healthcare can be difficult and, if we are unable to reach a new agreement, we will work with our Medicare Advantage and Commercial Group members to help them transition to another physician," Humana spokesman Mark Taylor said in a statement. "Humana maintains a large network of providers in Kentucky. We encourage our members to call Humana Customer Care if they need personal assistance."
Generally, patients face higher costs when seeing providers who are not in their insurance plan’s “network” of providers.
Still, Humana members may face disparate impacts from the dispute, according to Baptist.
“Some patients may be eligible for continued Humana insurance coverage of their treatment by a Baptist physician at discounted in-network rates or at higher, out-of-network rates, but they need to contact Humana to see if they qualify for either of those options,” Baptist said.
Medicare, the federal government’s health insurance program for older Americans, does not have insurance networks when seniors choose the traditional program.
But Medicare beneficiaries can choose to have their benefits administered via private health insurers like Humana and United Healthcare via the Medicare Advantage program.
Medicare Advantage offers more benefits than regular Medicare, often covering vision, dental and hearing, but in exchange seniors agree to be subject to restrictions like insurance networks and prior authorizations.
Neither Baptist nor Humana was able to quantify the number of people affected by the dispute.
Baptist Health Medical Group includes about 780 physicians and 870 advanced practice clinicians in 74 medical specialties, Baptist said.
Baptist said patients can find out more at this website.
Retired city and county employees, as well as state police, may be disproportionately impacted.
The Kentucky Public Pensions Authority provides retiree insurance through Medicare Advantage plans administered by Humana.
As of August, there were 60,397 people on the KPPA Medicare Advantage plans, according to the agency.
However, the agency was not able to say how many of 60,397 people are patients of Baptist Health Medical Group.
