Mercy Health warns it may drop Humana Medicaid and Medicare Advantage

Oct. 7—For the second time in just over a week, an area health care network is warning patients with Humana Medicaid and Medicare Advantage plans that they could find themselves out of network within the coming months.

Mercy Health on Tuesday released a statement saying the health care network and Humana have until Dec. 1 to reach an agreement.

"We recognize that patients who rely on Managed Medicaid or Medicare Advantage often face unique challenges and may be among the most vulnerable in our communities," said Dr. John Luellen, president of Mercy Health-Ohio, in a release. "When reimbursement rates are not sustainable and claims are frequently denied, it creates uncertainty and barriers to care for these patients and their families. We remain committed to resolving these negotiation thoughtfully and working to protect our patients from any gaps in their access care."

Citing issues with "denials, reduced or non-payment," and the creation of "significant operational burden," Kettering Health last week announced it will not be renewing its contracts with Medicare Advantage insurers Humana and Devoted Health at the end of the year.

Mercy Health cited similar issues in a posting to its website Tuesday.

"Unfortunately, what Humana pays our doctors, nurses and caregivers is not adequate to account for the cost of providing safe, quality care. By failing to offer sustainable reimbursement rates and address persistently high claims denial rates, Humana may be putting your in-network access to the Mercy Health facilities and providers you know and trust at risk," the post stated.

Representatives from Mercy Health and Humana have not responded to requests for additional comments.

Humana representatives last week indicated they were still in negotiations with Kettering Health.

The announcements are "frustrating" and "almost terrifying" for Beavercreek husband and wife Don and Jackie Nowak.

Both in their 70s, the couple has Humana as their insurance provider and sees doctors and specialists in multiple health care networks.

Don's primary physician and three specialists are through Kettering Health. Jackie sees doctors at The James Cancer Hospital.

They also use Premier Health and independent physicians for their health care.

"What we discovered with the Humana plan is everyone takes it," Don said.

Don said the idea of having to find and establish relationships with all new doctors is not something he and his wife want to deal with, adding he hopes negotiations with Humana are simply routine talks.

"I understand Kettering's position. I understand Hamana's position. It puts us in the middle," he said.

Kettering Health has 14 area medical centers and more than 120 outpatient locations throughout Western Ohio, as well as the Kettering Physician Network, which includes more than 700 board-certified providers.

Mercy Health has 23 hospitals and hundreds of clinics, urgent care and medical centers across Ohio and Kentucky, including locations in Springfield, and Butler and Warren counties.

With more than 14 million members nationwide, Humana Inc. is a Fortune 500 health care company based in Louisville, Ky., specializing in Medicare Advantage, Medicaid, group health insurance, and specialty health services.

© 2025 the Journal-News (Hamilton, Ohio). Visit www.journal-news.com. Distributed by Tribune Content Agency, LLC.