Medicare Advantage contract still under negotiation
As the deadline for people to make a final Medicare Advantage plan coverage decision looms, local hospitals are still negotiating with Humana as a possible provider. People have until February 28 to make a decision and Monida, which does contract negotiations for a number of Montana hospitals including Mineral Community Hospital, has not reached a final deal.
“I just received word yesterday (Feb. 7) that the contract is currently with the Humana legal department,” said Mineral Community Hospital CEO Ron Gleason.
Monida represents the Clark Fork Valley Hospital in Sanders County, St. Luke in Ronan, and hospitals in Philipsburg, Deer Lodge, Dillon and Sheridan as well as Mineral Community with contract negotiations. Blue Cross Blue Shield of Montana withdrew from the local market with their Medicare Advantage Plan, leaving only Humana to offer this type of plan. But there are some very real concerns for people regarding Humana said Gleason.
One of the main sticking points in the negotiations is Humana’s policy of not covering emergency department visits if they deem the visit a non-emergency. Gleason cited a case from another state where a patient was treated in the emergency room and six months later the insurance company refused to pay the bill. They claimed the visit was not an emergency and the patient was forced to pay the bill.
“For the company to look at records six months later and deny it, how do they know whether it’s an emergency or not?” he said. It’s an issue Gleason doesn’t want to see happen to any of their patients. But this leaves people who were previously covered under the Blue Cross and Blue Shield Medicare Advantage Plan searching for an alternative.
People can go back to a regular Medicare plan with the supplement part D or they can have a contract with the Humana Medicare Advantage Plan but the hospitals have to have a contract with them in order for Humana to pay the hospitals for services. Gleason also warns that there are a number of specialists in Missoula who also do not have a contract with Humana.
He said there are hundreds of options for people regarding Traditional Medicare and part D supplement plans available that the hospital will cover. People just need to talk to their insurance agents to determine which is best for them.
If a person has a regular Medicare Plan, it is administered through the Federal Government. With this plan, people can also buy supplemental insurance which pays for things like deductibles, copays, and other expenses the regular plan may not pick up. What an Advantage Plan does is roll all the plans into one plan and is administered through an insurance company.
The Humana Medicare Supplements are still covered by the hospital, it’s the Humana Medicare Advantage plan which is under negotiations.
“The problem with a Medicare Advantage Plan is once you do that, you have to stay with that plan unless, like in the case of Blue Cross Blue Shield, the company pulls out of the area that you are living in,” said Gleason. “If you make the decision to go with the Medicare Advantage Plan you are in it indefinitely.”
With the deadline to chose a plan just weeks away, Gleason said he would get the word out as soon as he gets more information regarding the Humana contract.