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Humana: CAMC wanted local network monopoly

CHARLESTON, W.Va. -- Negotiations between Humana and Charleston Area Medical Center broke down because the hospital wanted to be the only area hospital in the insurance company's network, Humana officials said.

Last month, the hospital unexpectedly told Humana it would leave the network in 2013, Jeff Blunt, a regional spokesman for the company, said in a statement issued late Wednesday.

"During our subsequent contract negotiations, CAMC made it clear their goal in negotiations with Medicare Advantage payers is to direct and steer volume to their facilities," Blunt said. "This is best achieved when they are the only participating hospital system in the network.

"It became clear in our conversations that Humana could not achieve its goal of preserving contractual relationships with both hospital systems in the Charleston area," Blunt said.

Hospital officials on Wednesday declined to say why CAMC intended to leave the network.

"We're always talking [with Humana officials]," Dave Ramsey, the hospital's president and CEO, said at a meeting of the hospital's board of directors. "I don't really want to go into specifics, but we're always hoping that things can be changed, improved. So, we'll continue to talk with them."

The hospital, in a statement issued Thursday afternoon, said Humana's concern about choice is unfounded.

"CAMC hospitals will still be accessible to Humana's beneficiaries, but will be considered out of network by Humana," hospital spokesman Dale Witte said in a prepared statement.

Witte provided a list of Medicare Advantage plans that will consider CAMC "in network." They include: Aetna Medicare, Health Plan of the Upper Ohio Valley Medicare, HealthSpring Medicare, Highmark Blue Cross Blue Shield Medicare, and Humana PEIA Medicare Advantage. The hospital will be considered in network for the following commercial plans: 4MOST, Aetna, Carelink, CIGNA, Health Plan of the Upper Ohio Valley, HealthSmart, Highmark Blue Cross Blue Shield, PEIA, SelectNet, TriCare, UMWA Funds and United HealthCare.

"As always, CAMC is committed to caring for its community and will do everything it can to assist any patients through this transition," Witte stated. "It is disappointing that Humana officials out of Louisville, Ky., have decided to attempt to negotiate a contract through media outlets."

Blunt said Humana is committed to continuing discussions with CAMC and hopes the hospital will reconsider its decision and remain in the company's network.

Ramsey said he was unsure how many patients would be affected by the change and how it would affect the hospital's bottom line.

Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.


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