NASHVILLE, Tenn. (WTVF) — Jerry and Karen Rollins say they face the same problem as other Metro pensioners.
"I personally would like to have my Medicare and my Blue Cross Blue Shield back," said Karen. She worked at Metro Water Services for more than 40 years.
In January the couple was switched to a Medicare Advantage Plan insured by Humana. The switch came after a 2021 decision by Metro leaders.
"Why wasn't this decision left up to the retirees to make a choice, rather than putting us all in one basket and saying 'one size fits all'?" Jerry said. "And it doesn't."
Then came a call from their doctor's office.
"And she says, 'oh, by the way, I meant to tell ya'll that as of April the first you're not going to have insurance with us anymore,'" said Karen. "I said, 'What?'"
Vanderbilt said it will no longer accept the Humana plan come April 1 following a dispute over reimbursement rates. But as the recipient of a liver transplant, Jerry worries his specialty care hangs in the balance.
"It's gut-wrenching, to say the least," said Jerry.
They said switching plans would cost them thousands, but staying with their current one could mean paying out of pocket.
While the Rollins hope the dispute comes to an end, they also hope Metro leaders will reconsider the switch.
"What we had," said Jerry. "In the very beginning."
In a statement, Humana said:
"Earlier this month, representatives from Humana and Vanderbilt University Medical Center met in person to discuss our existing provider contracts. Since that meeting, discussions between Vanderbilt and Humana have been continuing. As we have shared previously, Humana would like to retain Vanderbilt as an in-network provider, and we hope we can reach a new agreement prior to April 1 (the date on which Vanderbilt has indicated they will terminate our existing provider contracts if we do not have a new contract in place).
If we do not reach a new agreement by April 1, we will work with our members so they can transition to other medical facilities and doctors. Also, there may be circumstances where members could continue care with Vanderbilt providers for a specified period of time for continuity-of-care reasons."
In a previous statement, Vanderbilt said:
"Since November 2022, Vanderbilt University Medical Center (VUMC) has been attempting to negotiate with Humana for new reimbursement rates for the Medicare Advantage plan they offer Tennesseans. So far, Humana has not provided an acceptable response.
New reimbursement rates are necessary so that VUMC can be paid fairly for patients’ services while contending with inflationary costs for personnel, supplies, equipment, and medications necessary to provide high-quality care. These factors have caused declining margins for VUMC along with most of the nation’s nonprofit hospitals. Already, before these inflationary pressures, VUMC’s annual margin was in the 2-3% range.
Medicare Advantage plans are among the most profitable for health insurance companies. Humana highlighted their growth in Medicare Advantage membership as a key success metric in the most recent earnings release.
We continue to be willing to negotiate a reasonable rate increase before VUMC’s patients are no longer in-network for Humana’s Medicare Advantage plan.
Humana’s Medicare Advantage patients who can learn more at a dedicated website http://www.VUMCMedicareAdvantage.com or by calling our patient assistance line at 1-855-429-2989.”
