NASHVILLE, Tenn. (WTVF) — For months, their healthcare hung in the balance. Metro retirees were caught in the middle of a reimbursement dispute between Vanderbilt University Medical Center and Humana.
Among the retirees were Karen and Jerry Rollins.
"It's been a nightmare to say the least," said Jerry.
Come April, Metro retirees on Humana's Medicare Advantage Plan would lose coverage at Vanderbilt — a major problem for those with special care like Jerry.
"We were going to have to drive three-and-a-half, four hours away to get his blood work done and to see a transplant hepatologist up in Lexington, Kentucky or in Memphis, Tennessee," Karen said.
Then, just as the couple was prepared to leave their Humana plan behind, came the call.
"My doctor, her nurse called me and told me the information that 'congratulations, we're still in network with you Mr. Rollins,'" Jerry said.
After weeks in the dark, came a glimmer of hope — Vanderbilt and Humana finally reached an agreement following successful negotiations.
"Thank you, Lord," thought Karen. "Thank you, Lord."
But the Rollins' are still keeping their fingers crossed.
"Cautiously optimistic, yes to a certain degree because it's happened one time," said Jerry. "Won't know if it's gonna happen again."
Until then, they say they're just grateful and happy to put the ordeal behind them.
Vanderbilt University Medical Center and Humana released the following joint statement: "After successful negotiations, Vanderbilt University Medical Center (VUMC) and Humana have come to an agreement (awaiting final signatures) for VUMC to continue to provide services to Humana’s Medicare Advantage members covered on Individual and Group PPO plans and to Humana’s Commercial plan members.
Among the groups included in Humana’s Medicare Advantage PPO coverage are retirees of Metro Nashville Government.
VUMC and Humana have not reached an agreement for VUMC to continue to provide services to Humana’s Medicare Advantage HMO plan members, and to Humana’s Kentucky Medicaid members. As such, VUMC will be out of network for these members effective April 16, 2023.
Humana will be reaching out to its Medicare HMO and Kentucky Medicaid members to help them find new healthcare providers, to ensure they continue to have access to quality care through Humana’s remaining in-network providers."
In a statement, Mayor John Cooper said: “After months of intensive conversation, I’m pleased that Humana and Vanderbilt University Medical Center have reached an agreement that allows Metro retirees and thousands of other Davidson County residents on the Humana Advantage PPO plan to continue receiving care from VUMC physicians. Nearly 2,000 former Metro employees would have been forced to change doctors next month had we not been successful at finding a way forward. I’m grateful to both organizations, as well as a number of important Metro leaders including Kelly Flannery, Kristin Wilson, Mike Jameson and especially Shannon Hall for working diligently to get this done.”
