RALEIGH, N.C. (WNCN) – A dispute could soon impact health benefits for tens of thousands of North Carolinians enrolled in the state health plan.
We’re talking about Medicare benefits through WakeMed and Humana health care.
Negotiations between WakeMed and Humana regarding its Medicare Advantage contracts have dragged on for several months, and now WakeMed says those taking part in the plan will soon be considered out of network if the two sides can’t reach an agreement by the end of the month.
The state health plan covers 750,000 current and retired public employees and is the largest purchaser of health care in North Carolina.
Its Medicare Advantage plan under Humana covers about 175,000 retired state employees.
“90% of our retirees over the age of 65 are on the Humana Medicare Advantage product,” said State Treasurer Dale Folwell.
WakeMed says its primary concern with Humana’s Medicare Advantage plan is the high rate of denials on claims for care that the hospital has already provided, saying in an emailed statement:
“Humana currently denies claims at a rate that is 3-4 times higher than other Medicare Advantage payors we contract with.”
The hospital says if the dispute isn’t resolved by Oct. 30, state retirees on the Medicare Advantage plan will be considered out of network.
The state treasurer’s office oversees the health care plan and, in a Facebook post, advised retirees that even if WakeMed makes plan members go out of network, their costs will not increase.
Folwell explained to CBS 17 Consumer Investigator Steve Sbraccia that agreements have been made to ensure costs stay the same even if participants are forced to go out of the network.
“We have letters and affirmations that these hospitals are going to continue to see our state employees,” said Folwell. “There will be no difference in the services that get the doctors that they’re able to see or the reimbursement associated with any of that.”
That agreement also includes state retirees who use the Humana health care advantage plan at ECU Health Care facilities in the eastern part of the state.
In a similar dispute in Tennessee, a hospital system ultimately refused to see Humana Medicare Advantage plan patients even out of network.
There is no indication at this time that it will happen here.
When asked by CBS 17 for its side of the story, a Humana spokesperson said only it continues to work to reach a new agreement before the Oct. 30 deadline.