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CAMC-Humana Medicare Advantage impasse continues

CHARLESTON, W.Va. -- Negotiations between Humana Inc. and Charleston Area Medical Center about whether to provide benefits to Medicare Advantage recipients are apparently continuing.

However, if an agreement is not reached before the "open-enrollment period" ends next Friday, senior citizens who purchased Medicare Advantage health-plan benefits through Humana will not be able to get reimbursed for health care they receive at CAMC or from physicians at the hospital.

"To my knowledge there are not a lot of talks going on," CAMC spokesman Dale Witte said Wednesday. "There is nothing new going on, nothing new to report.

"I really don't anticipate anything. All the decisions have been made for next year."

Talks between Humana and CAMC broke down in September.

Jeff Blunt, a spokesman for Humana, based in Louisville, Ky., said last week that there was no "breaking news" to report.

However, talks between Humana and CAMC apparently have continued.

On Thursday, Blunt said, "There is nothing that I can share. We are still talking. We remain optimistic. Hopefully, I will have more news for you soon."

When hospitals are "outside" the network of an insurance company like Humana, patients covered by Medicare Advantage plans must pay the bills themselves for any care received at those hospitals.

Seniors eligible for Medicare can simply enroll in the government program or choose to enroll in private Medicare Advantage plans, which often provide additional benefits.

When Medicare recipients enroll in private plans, the government transfers federal money to those plans, plus an additional 17 percent.

"The open-enrollment period ends in a week, and I have been actively involved in these discussions on a daily basis and continue to encourage all parties to go back to the table to work out a compromise," Sen. Jay Rockefeller, D-W.Va., said Thursday. "We need to make sure West Virginia seniors can get the access to health services that they need. Too many seniors are caught in the middle of this dispute, and they certainly have the most to lose.

"This situation is unfortunate, and I'm hopeful that we can find a solution that protects seniors now and in the future so this doesn't happen again."

Rockefeller sent letters to top officials at Humana and CAMC on Oct. 31, asking them to resume negotiations and reach an agreement to cover patients before the open-enrollment period ends on Dec. 7.

If they sign up with one Medicare Advantage provider, Medicare recipients cannot change their providers for another year.

"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.

Perry Bryant, executive director of Charleston-based West Virginians for Affordable Health Care, said he recently talked to a woman insured by Humana who "needs to see doctors at CAMC.

"She was thinking about changing insurance providers so she could get the access she needs," he said. "When these institutions can't find middle ground, can't find any way to resolve this, she gets caught in the middle of everything. She might not be able to see doctors that she has had a long-standing relationship with."

The people impacted the most by these controversies are patients who are beneficiaries of Medicare Advantage groups, such as Humana, Bryant said.

"Unfortunately, they often end up paying the penalties for this kind of dispute," he said, "but there are a plethora of other insurance companies that will sell supplemental insurance plans."

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


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