Humana deal with Boca Regional shuts Obamacare policies out of network

Oct. 14--Humana Inc.'s renewed deal with Boca Raton Regional Hospital, two of the major health players in Palm Beach County, does not mean all patients can enjoy network access at relatively low prices, customers are finding.

A Palm Beach Post reader who says she gets a government subsidy under an Affordable Care Act plan with Humana says the hospital is not "in network" for her plan on the health care exchange.

That leaves "patients like me, who need surgery and have gone to in-network doctors with hospital privileges only at Boca Regional, between a rock and a hard place," she said. "Thank you very much Humana and Boca Regional."

Humana spokesman Mitch Lubitz confirmed the development.

"Your Post reader is correct," Lubitz said. "While Boca Raton Regional Hospital remains in Humana'sSouth Florida health care provider network for the next two years for our Medicare and Employer Group health plan members, Humana was not able to agree on rates with Boca Raton Regional for continued participation in 'HUMx,' or Humana'sHealth Insurance Marketplace individual exchange plan network in South Florida."

In Palm Beach County, Humana's 2015 exchange network hospitals include Bethesda Memorial and Wellington Regional, he said. Humana said it also has a number of participating Broward hospitals in its exchange network, including all the Broward Health Hospitals and the Memorial Health System.

Humana has informed its affected marketplace plan members in Palm Beach County that Boca Raton Regional is no longer in its exchange network, he said.

He declined to say how many people are affected.

"We won't characterize the number of Humana individual exchange members affected by the network change as we consider Marketplace membership to be competitive information," Lubitz said. "However, Humana is constantly evaluating its health care provider network, always seeking to balance access with affordability, and that's an even more important consideration for the exchange network, when many of those South Floridians seeking health insurance coverage qualify for federal subsidies."

A Boca Raton Regional Hospital spokesman said the various Humana plans are different products and declined comment on why it could not reach a deal on exchange policies.

The reader, who asked not to be identified, sees "lots of politics" at work. She added, "Humana is being cooperative in helping me make other arrangements for my surgery through a different provider and hospital."

The Post reported last week that Humana renewed a two-year deal with Boca Raton Regional Hospital that provides continued network access for health plan members. The extension, which took effect Oct. 1, ensures members who enroll in Humana Medicare plans during the upcoming enrollment period -- Oct. 15 through Dec. 7 -- will be able to receive in-network services.

The renewal applies to Humana Medicare and Employer Group HMO and PPO plans and includes all Boca Raton Regional-employed physicians and specialists, such as BocaCare, Boca Urology and Surgical Associates of Palm Beach, the company said.

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