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Humana dropping Thomas, Saint Francis for Medicare plans

CHARLESTON, W.Va. -- Humana, a Lexington, Ky.-based company that provides Medicare supplement plans, will no longer pay for medical visits and care at Thomas Memorial Hospital in South Charleston and Saint Francis Hospital in Charleston after Feb. 1.

Stephen P. Dexter, CEO of the Thomas Health System, found out about Humana's decision on Dec. 6, when he received a letter, dated Nov. 30, from Beverly Steen, Humana's director of contracting.

Steen's letter provided no detailed explanation about why Humana was withdrawing from its contracts with the Thomas Health System.

"The dynamics in the Charleston area have changed and the ChoiceCare network is reconfiguring its network," Steen wrote. "Your ChoiceCare Network agreement is terminated without cause effective 2/1/2012 for all lines of business."

In her letter, Steen said the "agreement [between Humana and Thomas] shall automatically renew for subsequent one-year terms unless either party provides written notice of non-renewal to the other party at least 90 days prior to the end of the initial term or any subsequent renewal terms."

During an interview last week, Dexter said, as of now, "We are still in the network. We want to stay in the network. Our doctors want to stay in the network."

Paige Johnson, director of marketing and public relations for the Thomas Health System, said, "There has been nothing wrong done by either hospital in the services we provide.

"This was a complete blindside," she said. "We will do everything we can to contest this issue."

Dexter believes "Medicare patients ought to be able to choose their hospitals and doctors. Denying them that choice is not part of the Medicare program.

"We think this is totally inappropriate. We want our patients to contact our elected officials," he said.

    Sen. Jay Rockefeller, D-W.Va., who follows health issues closely, said on Saturday, "I'm currently looking into this situation. Seniors absolutely must be able to get access to quality, affordable health care."

Joe Kuchler, a press officer for CMS, based in Washington, D.C., said on Friday that his agency will look at Humana's relationship with the Thomas Health System early next week and answer questions.

(CMS stands for the Centers for Medicare & Medicaid Services -- the federal agency that administers Medicare, Medicaid and the Children's Health Insurance Program.)

Steen's letter to Dexter gave the Thomas Health System a 56-day notice, with no specific explanation about reasons for the termination.

In a Dec. 22 letter to Steen, Dexter pointed out that "...as correctly noted in your letter, at least 90 days of written notice of non-renewal to the other party must be given.

"This has not been done. For this reason, the agreements continue in full force and effect." Dexter wrote in his letter.

"All of a sudden, some of our patients were told, 'Your hospital is no longer in the plan.' Some people have been our patients for 30, 40 or 50 years," Dexter said.

"When patients come into the ER [emergency room], the nurses know their names. Patients know their doctors. At a new hospital, patients won't know anyone. They will be taken out of their element of comfort."

Steen, who is on vacation, did not respond to telephone messages and emails on Thursday and Friday. Telephone calls were switched to Darling Roberts, from Humana's provider operations department. Roberts did not return the call.

Jim Turner, Humana's corporate public relations officer, did not respond to several telephone calls to his office and cell phones on Thursday and Friday.

State workers receiving health benefits through the West Virginia Public Employees Insurance Agency who signed up with Humana will still be able to receive care through the Thomas Health System, Dexter said.

'We've been getting dozens of phone calls from other patients," Dexter said.

"We have 22,000 patients who visit us for lab tests, X-rays and other reasons. We have all the medical history for those patients."

Medicare beneficiaries who want to continue being patients in the Thomas Health System can go back to straight Medicare coverage," Dexter pointed out.

But they cannot switch to another "Medicare Advantage" plan since the annual deadline for applying for annual coverage is in early December.

"These plans came to the Charleston market four years ago," Dexter said. "The plans are new to this area."

Humana did not inform its local Medicare beneficiaries of their decision until they sent out letters dated Dec. 21.

"We are writing to tell you that as of February 1, 2012, Saint Francis Hospital will no longer be in your Humana Medicare plan network," one letter stated. "This change doesn't affect your benefits.... When you need to go to a hospital, your primary care physician can help you choose the hospital that is right for you."

Thomas purchased Saint Francis Hospital in 2007.

Gaylene Miller, state director of the American Association of Retired Persons, previously said there are advantages and disadvantages for patients who sign up for networks developed by various Medicare Advantage plans.

"I urge consumers to look very carefully when they are signing up for a Medicare Advantage plan to cover their health needs," Miller said.

Medicare recipients have the annual option to register with a private provider, which is paid by Medicare to provide benefits. Those plans often provide additional benefits, such as pharmaceuticals.

People enrolling for benefits from private providers typically must sign up between Oct. 15 and Dec. 7 each year.

Reach Paul J. Nyden at pjnyden@wvgazette.com or 304-348-5164.

 

 


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