WakeMed, Humana fail to reach new Medicare Advantage agreement. Who will be affected?
WakeMed and Humana failed to reach an agreement before their Monday deadline, allowing several Medicare Advantage Plan contracts to lapse.
WakeMed facilities will now be considered “out-of-network” for those insured by the PPO or HMO plan. A spokesperson for WakeMed could not provide the number of patients who would be affected by this dispute.
Notably, the lapsed contract does not impact state retirees, said Debbie Laughery, a WakeMed spokesperson. Those patients, who receive Humana insurance through the State Health Plan, “remain covered,” she said.
A Humana spokesperson said the company was still working with WakeMed to reach a resolution. In the meantime, Humana said it would work with the impacted members to find new in-network providers.
The heated negotiations became public earlier this month, when Humana sent a letter, informing members that WakeMed would soon be considered out-of-network.
A WakeMed spokesperson said “good faith” negotiations had failed due to Humana’s high rate of health claim denials and refusal to set up systems that allow providers to resolve disputes about necessary care.
This is one of several high-profile insurance disputes to happen in the Triangle this month. UNC Health is in the midst of contract negotiations with UnitedHealthcare. ECU Health is also in a dispute with Humana.
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
This story was originally published October 31, 2023 at 3:40 PM.
