Baptist Health, Humana restore ‘in network’ coverage for Medicare Advantage patients

Kentucky Lantern

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Baptist Health and Humana have ended a months-long standoff over Kentuckians with health coverage through Medicare Advantage and commercial insurance plans, the two companies announced Thursday.

Effective April 1, Baptist physicians again will accept those patients as “in network”— meaning they would not be subject to potentially higher costs or limits on services.

The news, which affects tens of thousands of Kentuckians including many state retirees, was announced through separate press releases.

“After several months of productive negotiations, Humana is pleased to have reached a new, multi-year agreement with Baptist Health Kentucky,” Eric Bohannon, Humana Medicare regional president, said in the release.

Baptist hailed the move as good for patient care.

“We are committed to improving the health of our communities and our goal is to ensure every patient the high-quality, timely care needed,” said Dr. Isaac J. Myers II, chief health integration officer for Baptist Health.

The news releases didn’t detail how the two resolved differences that led Baptist Health to drop Humana as a network provider for its physicians on Sept. 22.

But Medicare Advantage plans, which oversee health care for many Medicare enrollees, including around 102,000 Kentucky state government retirees, have been a growing source of contention between health providers and the private insurance companies that offer them.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in an email statement in January.

Effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network.

Barry said Thursday Baptist has not reached agreements with United or Wellcare.

The growth of Medicare Advantage plans, which now cover about half of those 65 or older nationwide, has been a source of increasing concern to health advocates who argue the patients suffer through practices such as denials of care, delays while care is authorized and other restrictions.

Among them is longtime Louisville health reform activist Kay Tillow who told the Lantern in January that such plans are sacrificing the benefits of Medicare for seniors.

“The profit motive is destroying patient care,” Tillow said.

Insurance companies that provide Medicare Advantage plans argue they offer better care at less cost and, in some cases, extra benefits to seniors.

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