NMHS preps for split with Humana Medicare Advantage

Dec. 06--TUPELO -- When 2019 rings in, North Mississippi Health Services will no longer be an in-network provider for Humana Medicare Advantage members.

The Tupelo-based health care system and insurer were not able to resolve their dispute. The hospital system signaled in May it was not renewing its agreement citing an unusually large number of claims denials.

The change affects hospitals in Tupelo, Pontotoc, Iuka, West Point, Eupora and Hamilton, Alabama, imaging and surgery centers, affiliated clinics and employed physicians. Those who have commercial Humana insurance through their employer or Medicare supplement plans are not affected.

Humana Medicare Advantage members will still be able to seek emergency medical care at NMHS hospitals for conditions like heart attacks, strokes, respiratory distress or trauma injuries. For the most part, they will no longer be able to schedule elective procedures at NHMS facilities, according to guidance released by North Mississippi Health Services late Tuesday.

Humana Medicare Advantage members with questions can call the Humana customer service on their ID cards.

"They will assist members in identifying in-network doctors, hospitals and specialists, and answer their questions and concerns about the pending network contract termination with NMHS," said Mitch Lubitz, a Humana spokesman.

Humana's area sales and service office at (601) 605-5130 also has licensed insurance agents available to review Medicare coverage options and choices.

Some Humana Medicare Advantage members may be able to receive care at in-network rates under two exceptions -- continuity of care or a waiver. Otherwise, they have to be prepared to pay out-of-network rates for care, which typically has a higher co-pays.

The responsibility for communicating with the insurer will fall to patients.

"It is very important that the Humana (Medicare Advantage) 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," a health system statement said.

Continuity of care applies to patients who are under existing treatment plans with an NMHS provider. Humana has mailed continuity of care letters to about 4,600 Humana Medicare Advantage members, but NMHS does not have access to those letters because the provider agreement is ending.

Humana Medicare Advantage members may also be able to apply for a waiver to use NMHS facilities under federal rules if the in-network provider for a service is outside a specific radius. Likewise, the patients will have to coordinate these waivers with Humana.

Options

Medicare Advantage members can consider switching to traditional Medicare.

Medicare open enrollment ends Friday. There is also a grace period from Jan. 1 to March 31 for Medicare Advantage members to switch back to traditional Medicare Parts A and B as well as sign up for Part D drug coverage.

Many people in traditional Medicare consider a supplemental plans to cover the costs that Medicare does not, if they qualify medically.

Assistance is available through local insurance agents or cms.gov.

Updated to clarify that Humana Medicare Advantage program in Mississippi operates as a preferred provider organization. That allows members to seek care outside the network, typically at higher costs.

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