NMHS cuts ties with Humana on Medicare policy

NMHS RELEASE

North Mississippi Health Services (NMHS) and Humana will officially cut ties January 1st, as the provider and insurer have failed to come to an agreement on a Medicare Advantage (MA) contract, NMHS confirmed Nov. 30.  Effective January 1, 2019, our healthcare facilities (hospitals, imaging and surgery centers) and employed physicians are out of network with Humana Medicare Advantage.

This contract dispute does not impact Humana Commercial group members through employer sponsored health plans in the region. The contract termination is specific to individuals who have purchased a Humana Medicare Advantage Plan.

NMHS notified Humana back in May that it would not renew the Medicare Advantage agreement under the existing terms because an unusually large number of claims denials have occurred with NMHS providers.  The denial issue, coupled with an egregious amount of administrative tasks and costs tied to the prior authorization and reimbursement process for Humana members, led to our business decision to terminate the contract.

BELOW IS A Q AND A ON THE IMPACT OF THE DECISION

Impact of the Change to Out of Network Status

With NMHS moving to Out-of-Network status, Humana MA members will no longer be able to schedule elective procedures at NMHS locations or with NMHS providers. For elective procedures, Humana MA members will need to locate an in-network Humana provider.

Continuity of Care and Waiver Situations

For some Humana members, Continuity of Care scenarios may exist (such as a member undergoing an existing treatment plan with an NMHS provider). NMHS has received confirmation from Humana that Continuity of Care letters were mailed to some 4,600 Humana MA members in the region. Humana also informed NMHS that since NMHS will be an Out of Network provider, Humana will be unable to share any internal documents specific to this detail item, including the actual member letter itself. As such, it is very important that the Humana MA members understand that the obligation for providing any requested information to Humana will be the responsibility of the member. NMHS will no longer be in a position to assist in this documentation requirement process.

In addition, NMHS received notice from the Humana Clinical Intake team that members may potentially qualify for a “Waiver” if a health care provider (such as NMHS) is outside a specific mileage radius determined by the Center for Medicare (CMS). Completing the details tied to this waiver documentation requirement will also be the responsibility of the member.

Members requiring assistance in completing either form (Continuity of Care or Waiver) will be routed to Humana Customer Service in both of these situations.

What Options Exist for Medicare Members in the Community

With NMHS providers exiting the Humana Medicare Advantage PPO network, members are faced with two choices (1) drop their coverage with Humana and enroll in traditional Medicare and add a Medicare Supplement, plus consider adding a Part D prescription drug plan or (2) find another provider who participates in the Humana Medicare Advantage PPO network.

NMHS is a Medicare provider and accepts a wide range of Medicare Supplement plans. A listing of Medicare Supplement plans is located on the Mississippi Department of Insurance website www.mid.ms.gov

Feedback from the Insurance Agents in the Region

Many local community Medicare eligible members have already taken the steps necessary to address this required change during the Annual Medicare Open Enrollment process.

Local insurance agents have seen a large turnout of members seeking information and guidance on the steps in moving to a Medicare Supplement plan. Reports of 50 individuals per day requesting information from local brokers have been very common. Plus, the actual transition rate of current Medicare Advantage members to traditional Medicare and Medicare Supplement carriers has been very high.

Details for the Annual Open Enrollment period can be located on www.cms.gov

When’s the Medicare Open Enrollment Period?

Every year, Medicare’s open enrollment period is October 15 – December 7.

What’s the Medicare Open Enrollment Period?

Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

Where can people find Medicare plan information or compare plans?

1-800-MEDICARE or Medicare.gov

What can Members do who missed the opportunity to change plans during the Annual Open Enrollment Window – What’s next?

Medicare Open Enrollment Period Returns in 2019

In 2019, you have a “grace period” within Medicare. Usually, when it comes to Medicare Part D and Medicare Advantage Plans, you can only switch your plan once a year. That is changing in 2019 with the return of the Medicare Open Enrollment Period (OEP).

• The 2019 Medicare Open Enrollment Period will run from January 1st through March 31st.

This return of this enrollment period will allow Medicare Beneficiaries that are currently “locked in” to their Medicare Advantage Plan an additional opportunity to change their plan after the effective date. This turnabout is a substantial comfort for Medicare Beneficiaries on Medicare Advantage Plans.

Those on a Medicare Advantage plan will have a one-time chance to:

• Drop your Medicare Advantage Plan and return to Original Medicare, Part A and Part B
• Sign up for a stand-alone Medicare Part D Prescription Drug Plan. Usually a Medicare Advantage Plan includes drug coverage. Once you sign up with a Part D Prescription Plan it will drop you from your Medicare Advantage Plan and return you to Medicare Part A and Part B. You can enroll in a Medi-gap (Medicare Supplement Plan) once you are no longer on a Medicare Advantage Plan, if you can medically qualify.

I Just Signed Up for my Medicare Advantage Plan: Why Would I Want to Change Already

• Medicare Advantage Plans must cover at least the same benefits as Original Medicare. However, some Medicare Advantage Plans provide extra benefits, and these extras can change on a yearly basis.
• One of the biggest reasons people choose Medicare Advantage Plans is they think they have some dental, vision, and hearing benefits included.
• Another crucial reason people want to drop their Medicare Advantage Plan is due to the provider network changes with hospitals and doctors.

Who can I talk with to get help with the Medicare Open Enrollment process?

• Talk to a local Insurance Agent of your choice about the upcoming 2019 Medicare Annual Election Period today.
• It’s important to be aware of all the options available to you during the Medicare Annual Election period.
• There are a great number of different plans available, but only certain ones will give you the coverage you need.
• Or, you can actually compare benefits and enroll online at www.cms.gov