CHARLESTON, W.Va. -- Sen. Jay Rockefeller, D-W.Va., sent letters to top officials at Humana Inc. and Charleston Area Medical Center on Oct. 31, asking them to resume contract negotiations and reach an agreement to cover patients before Medicare's "open enrollment period" ends Dec. 7.
CAMC plans to leave Humana's network next year. In September, talks between Humana and the hospital system broke down.
People eligible for Medicare benefits can choose a private insurance company, such as Humana, to manage their benefits under Medicare Advantage Health Plans. Humana and other private companies typically receive the annual money set aside for Medicare beneficiaries, plus an additional 17 percent, to help them pay their health-care bills.
"We are again facing a situation where access to health services for West Virginia seniors may be seriously curtailed because of business decisions that seemingly put profits before patients," Rockefeller wrote.
When hospitals are "outside" the network of a company like Humana, Medicare patients covered by Medicare Advantage plans must pay the bills themselves for care received at those hospitals.
Jeff Blunt, a spokesman for Humana, which is based in Louisville, Ky., said Monday there is no "breaking news" to report.
"We are still in communication with CAMC and we are still hopeful that a compromise can be reached. But beyond that, there is nothing new," he said.
Elizabeth Pellegrin, CAMC's chief marketing officer, also said Wednesday that there are no new developments, but that 12,000 Public Employees Insurance Agency Humana members would remain in CAMC's network.
West Virginia's Public Employees Insurance Agency provides retirement pay and health benefits to retired state workers.
But there are no current negotiations between CAMC and Humana about covering Humana's other Medicare Advantage beneficiaries, Pellegrin said.
"They will be with us until Dec. 31," she said. "Then they will be treated as being outside the network.
"This is an open enrollment period. This is the time for people to choose a Medicare Advantage plan. If they want to change insurance plans, they can.
"Or they can use straight Medicare as well," Pellegrin added. "Some physicians don't take Medicare. Most hospitals do."
In his letter to Humana CEO Michael McCallister, Rockefeller wrote, "I request that you immediately inform your current Medicare Advantage enrollees and those seeking more information about Medicare in West Virginia that CAMC is not currently planning to participate in Humana's network for 2013."
Recently, CAMC ran newspaper advertisements listing other Medicare Advantage plans that still include CAMC, including: Aetna Medicare, Health Plan of the Upper Ohio Valley, HealthSpring Medicare and Highmark Blue Cross Blue Shield Medicare.
"When you are selecting your health insurance plan for 2013, be sure to check that your preferred physicians and hospitals are available through your plan," the CAMC advertisement stated.
Stephen P. Dexter, CEO of the Thomas Health System that includes Thomas Memorial and Saint Francis hospitals, said, "this is not good news for senior citizens in the Kanawha Valley.
"We have really worked well with Humana. The program helps people move back home, get home health care, go to nursing homes and keep in contact with their families."