Humana Network Change Updates
The below information was shared with partner agents by Humana on 10/21/2020
- Beginning January 1, 2021 M Health Fairview and CentraCare will no longer be in the Humana Medicare Advantage plan network.
- In order to ensure that there are no gaps in care and to protect members from provider disruption resulting from this network change, all Humana members who receive care from M Health Fairview or CentraCare facilities will pay in-network cost shares for medically necessary Medicare Advantage-covered services as outlined in their plan Evidence of Coverage through 2021.
- For 2021, Humana’s Minnesota service area remains unchanged; however, we will not pay commissions for new plan enrollments in Stearns county.
- Humana members who have questions about this change can call Customer Service at the number on the back of their Humana ID cards for additional information or for help in selecting other providers to help manage their care.
- Members still have the opportunity to change plans after the first of the year during OEP. They do not need to change during AEP.
- A communication directly to members and a press release is being worked on; however, all member communications require CMS approval. It is possible that it will take a month or more for members to receive a letter of explanation from Humana regarding how claims are being paid in 2021.
- Download a sample of the letter your clients received from Humana so you can see how we’ve communicated the change. Please note, this letter does not reflect members’ in-network cost sharing.
- Humana is disappointed that these providers initiated this termination in the midst of the COVID-19 pandemic and immediately preceding the AEP. We remain open to discussions with these providers.
Message from CentraCare
As you have already heard, effective Jan. 1, 2021, CentraCare Health and Carris Health will no longer participate in the Humana Medicare Advantage plans. It has come to our attention that Humana has communicated to brokers that Humana recently reached a deal with CentraCare that will keep CentraCare in-network. This is not accurate. Humana has made a decision to cover their patients as if CentraCare were in-network. This is a decision completely on the part of Humana and is not an agreement CentraCare has made with Humana. I do not know Humana’s capacity to make this happen smoothly and keep the member of the middle, nor do I know how long they may do it.
There has been questions as to why CentraCare left the Humana Network and implications that this decision was financially motivated. Our reasons for leaving were not financial – Humana pays us the same as regular Medicare. The reasons have to do with barriers to care that Humana puts up, most recently around caring for COVID patients. The energy and work providers need to put in to take care of patients is far beyond the work needed with other Medicare Advantage plans and we were unwilling to fight those battles daily just to take of our patients. It is unfortunate that we were not able to effect change e in the Humana process. CentraCare and Carris continue to participate in the HealthPartners, Blue Cross, UCare, and Medica Medicare Advantage plans.
If you have questions or concerns, please feel free to contact me directly. 320-656-7060.
Vice President, Population Health
Message from M Health Fairview received on 11/17/2020
We’re reaching out to the brokerage community to correct misinformation around our current relationship with Humana. As you may know, effective January 1, 2021, M Health Fairview will no longer be in-network in Humana’s Medicare Advantage health plans.
We’ve learned from brokers and patients that after January 1, Humana intends to extend coverage for their members as though M Health Fairview providers and facilities are in-network. If this is true, please know this is a decision on Humana’s part and has no basis on any agreement we have with them.
As of January 1, 2021, we will not schedule office visits or elective procedures for those patients with Humana insurance and are recommending patients seek other coverage if they plan to seek care from M Health Fairview in 2021. Exceptions will be made for continuity of care and in cases where M Health Fairview is the only provider with the ability to provide the services needed. All patients who present to our emergency rooms will be treated regardless of their insurance coverage or ability to pay.
M Health Fairview providers and facilities are in the Medicare Advantage network for all the large regional payers including, Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, UCare and UnitedHealthcare.
VP Revenue Management
Fairview Health Services