Dispute between Humana and VUMC could leave Metro retirees searching for new medical care

Posted at 4:21 AM, Feb 06, 2023
and last updated 2023-02-06 05:21:56-05

NASHVILLE, Tenn. (WTVF) — Hugh Jarratt enjoyed more than 30 years with Metro's Police Department. At the end of his career was the promise of a pension.

"Well my health insurance coverage at the time I retired was Blue Cross Blue Shield and then when I turned 65 I went on to Medicare," said Hugh.

But in 2021 Metro leaders voted to change health care coverage for retirees like Hugh. "They switched us over, we didn't ask to be switched," he said.

Hugh said they were forced into a Medicare Advantage Plan insured by Humana that took effect last January.

"Why does everybody else in the whole government... get a choice of three plans, but the old people get no choice," said Hugh's wife Josie. "They railroaded us into this plan of which it is not a good plan."

Then came a recent doctor's visit. "They handed us a letter saying that we would not be serviced after April 1st," said Hugh.

Now Vanderbilt will stop accepting Humana's Medicare Advantage plan come April 1st.

Josie said, "I'm worried sick that something's going to happen to him and there is nobody around here that can handle but Vanderbilt."

With the deadline is looming, the couple worries Hugh's specialty care will come to an end too.

"We can't go back to Vanderbilt, period," said Hugh. "We can't go to any facility."

In a statement, Humana said: "On Dec. 21, 2022, Vanderbilt University Medical Center, together with its associated physician, ancillary centers, and affiliates (collectively, “VUMC”) notified Humana of VUMC’s intent to terminate the existing provider contracts between Humana and VUMC, effective April 1, 2023. VUMC indicated that it would agree to a new contract only if Humana will start paying 20 percent more for all services VUMC provides, starting April 1.

Humana would like to retain VUMC as an in-network provider, and we hope to reach a new agreement with VUMC prior to April 1, 2023. We are committed to doing everything we can to reach a resolution to the contract issue. And we look forward to meeting in person with VUMC soon to discuss the matter.

If we are unable to reach a new agreement, we will work with our members to help them transition to other medical facilities and doctors. Humana maintains a large network of hospitals, physicians and specialists in the Nashville area. Also, there may be circumstances where members could continue care with VUMC for a specified time for continuity-of-care reasons. We encourage our members to call Humana Customer Care if they need personal assistance."

Vanderbilt also issued the following statement: "Since November 2022, Vanderbilt University Medical Center (VUMC) has been attempting to negotiate with Humana for new reimbursement rates for the Medicare Advantage plan they offer Tennesseans. So far, Humana has not provided an acceptable response.

New reimbursement rates are necessary so that VUMC can be paid fairly for patients’ services while contending with inflationary costs for personnel, supplies, equipment, and medications necessary to provide high-quality care. These factors have caused declining margins for VUMC along with most of the nation’s nonprofit hospitals. Already, before these inflationary pressures, VUMC’s annual margin was in the 2-3% range.

Medicare Advantage plans are among the most profitable for health insurance companies. Humana highlighted their growth in Medicare Advantage membership as a key success metric in the most recent earnings release.

We continue to be willing to negotiate a reasonable rate increase before VUMC’s patients are no longer in-network for Humana’s Medicare Advantage plan.

Humana’s Medicare Advantage patients who can learn more at a dedicated website  or by calling our patient assistance line at 1-855-429-2989.”