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Despite dispute, Humana to cover 'out-of-network' care at CAMC

CHARLESTON, W.Va. -- Although Humana Inc. and Charleston Area Medical Center have not reached an agreement about covering Medicare Advantage patients, a Humana spokesman said patients can be offered "out-of-network" benefits.

If an agreement is not reached by the open-enrollment period deadline on Friday, seniors enrolled in the Humana "Medicare Enhancement" program will end up paying more for benefits at CAMC, because it will not be in Humana's covered health-care system.

However, Jeff Blunt, a spokesman for Humana, said Friday that Humana's plans do offer out-of-network benefits.

"So, even if it works out that CAMC is not in our network next year," Blunt stated in an email, "our members will be able to get reimbursed, albeit at a lesser rate than at participating hospitals, for care received at CAMC.

"The amount of reimbursement varies, of course, according to the plan they choose, but there is an out-of-network benefit. So, unless CAMC were to turn them away, Humana members would be able to seek care at CAMC and be reimbursed even if they are not in network."

On Oct. 31, Sen. Jay Rockefeller, D-W.Va., sent letters to top officials at Humana and CAMC asking them to resume contract negotiations and reach an agreement to cover patients before the open-enrollment period ends.

Medicare recipients must decide annually whether to stay on regular Medicare, administered by the federal government or join one of the Medicare Advantage Health Plans available to them privately.

Abigail McDonough, Rockefeller's press secretary, said Virginia can learn more about their health-care plans, as well as alternative private plans -- such as that provided by Humana -- and payment services, by contacting the state's senior services office.

The West Virginia State Health Insurance Assistance Program, begun in 1992, provides free, objective and confidential help to Medicare beneficiaries and their families, McDonough said.

WV-SHIP, located at 1900 Kanawha Boulevard East in Charleston, can be reached at its toll-free telephone number: 1-877-987-3646. The group's website is: www.wvship.org.

The WV-SHIP website also provides a 2013 Medicare Costs fact sheet, listing premiums and deductibles for Medicare Part A, that covers hospital insurance, and Medicare Part B, which covers other medical insurance. The site also includes information about Medicare Part D, which covers prescription drugs.

More information also is available from the federal government's Medicare offices, at 1-800-MEDICARE.

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


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