State retirees caught in middle of contract dispute between WakeMed and insurer Humana
Tens of thousands of retired state employees found themselves caught in the middle of insurance disputes this month after Humana — the state health plan’s Medicare Advantage administrator — informed them WakeMed would soon be considered out-of-network.
A Humana spokesperson said the letter was sent to members after WakeMed said it intended to end its Medicare Advantage contract with Humana on Oct. 30. This contract dispute would affect about 175,000 retired state employees enrolled in the plan.
A spokesperson for the health system said “good faith” negotiations have 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.
“We recognize how difficult this situation is for the patients we serve,” a spokesperson said in a statement. “We continue to work with Humana to come to a reasonable agreement and are hopeful one will be reached before the October 30 termination date.”
The state’s Medicare Advantage plan allows members to see out-of-network providers for the same out-of-pocket costs as in-network providers, as long as they accept Medicare.
But state health plan leaders feared the health care system would stop seeing Humana patients altogether. Earlier this year during contract negotiations, Vanderbilt Health system in Tennessee threatened to stop accepting Humana’s Medicare Advantage plans even on an out-of-network basis.
Sam Watts, the director of North Carolina’s State Health Plan, said WakeMed agreed Wednesday to see all state health plan members out-of-network, even if no new contract is in place by the end of the month.
If that agreement is honored, benefits and costs would remain the same for state health plan members. A Humana spokesperson said the company is still “working to reach a new agreement prior to the effective date.”
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 18, 2023 at 2:16 PM.
