Talks between Humana and Baptist Health continue

Negotiations may leave area patients in dust

Practitioners at Baptist Health facility may soon not be considered in-network providers for those covered by Humana Medicare Advantage plans as the companies have yet to agree to a new deal ahead of their September deadline.

Baptist Health and Louisville-based insurance company Humana have been working to negotiate a new contract by Sep. 22, according to a news release. If the groups are unable to secure an agreement, Baptist Health Medical Group providers would be affected, but hospitals would remain in the network.

“Our community relies on us to provide high-quality health care services. We are working hard to ensure there is no disruption in medical care for our patients,” Baptist spokesperson Kit Fullenlove Barry said. “Baptist hopes to reach a new arrangement with Humana prior to Sept. 22 for all insurance plan members.”

Here’s what we know about the impact a new contract could have on patients so far.

Which Humana insurance plans will be affected?

Some common Humana plans that could be affected are listed below, but the list may not be all-inclusive, according to the Baptist website. Only Humana is able to confirm what will affect an individual’s plan.

● Humana Choice PPO

● Humana Honor PPO

● Humana Value Plus PPO

● Humana USAA Honor PPO

● Humana Gold Plus HMO

Will I have to pay more if I see a Baptist provider?

Some people might be eligible for out-of-network benefits or access to coverage via a secondary or supplemental network through the Continuity of Care program, officials at Baptist Health

said.

Without Continuity of Care, however, patients may have to pay more to see Baptist Medical Health Group providers after Sep. 22, officials said.

What is Continuity of Care?

“Continuity of care flows out of the federal No Surprises Act, which covers billing issues,” Fullenlove Barry said.

Continuity of Care can help patients continue to see their doctor for at least a temporary period of time if their insurance coverage is disrupted, according to a webpage.

There may be strict rules on the process, and patients must show a good reason, according to Insure.com.

What if I’m being treated for an ongoing condition at a Baptist Health Medical Group doctor?

Some medical conditions are guaranteed in-network rates by law through Continuity of Care, according to Baptist’s webpage. Some examples include: pregnancy, chronic medical conditions and ongoing and active medical treatment such as chemotherapy or dialysis or home healthcare services. However, only Humana can determine if individuals qualify. Humana spokesperson Mark Taylor said the company recognizes how difficult changes to an individual’s medical insurance can be.

“Humana maintains a large network of providers in Kentucky. We encourage our members to call Humana Customer Care if they need personal assistance,” he said.