Baptist Health is headed out of network with UnitedHealthcare and Wellcare Medicare Advantage plans, after losing Humana

Photo by John Lair, Louisville Public Media

If negotiations this month don't find agreement that has been elusive so far, Louisville-based Baptist Health will no longer be in the Medicare Advantage networks of UnitedHealthcare and WellCare. It has been out of network with Louisville-based Humana for two months.

"In-network rates for medical care are generally more affordable than out-of-network rates," explains Morgan Watkins of Louisville Public Media. Patients pay less out of pocket for services from an in-network provider.

Baptist Health "has cited concerns about various Medicare Advantage plans routinely denying or delaying approvals of or payments for medical services recommended by patients’ doctors," Watkins reports. "The health system said it has been trying to negotiate new contracts with several insurers."

When that didn't work with Humana, Baptist Health and its clinicians left the insurer's network in September. Starting Jan. 1, it will no longer be in the UnitedHealthcare and WellCare networks, unless negotiations forge an agreement. Baptist has alerted its patients.

Baptist spokesperson Kit Fullenlove Barry told Watkins, “It remains our top priority to secure agreements with Medicare Advantage plans that protect our patients’ access to the medical care they need and allow medical care decisions to be made by the patient and their doctor, not an insurance company.”

UnitedHealthcare, the nation's largest health insurer, told Watkins it still hopes to reach an agreement with Baptist, Kentucky's largest hosptal chain: “Our top priority is to renew our relationship with Baptist Health and ensure continued access to the health system for people enrolled in our Medicare Advantage plans. We are committed to continued good-faith negotiation and using the remaining time on our contract to reach a new agreement.” Wellcare did not comment.

A person with an HMO plan could face “significantly higher” out-of-pocket costs starting next year, Baptist said in a letter to patients. But if a patient applies for “continuity of care” benefits, for patients who are pregnant or receiving chemotherapy or dialysis, the Medicare Advantage plan would have to temporarily cover their care at Baptist with in-network rates.

Advantage plans have lower costs, but with limits on befefits and providers. Original Medicare has no such limits. Also, Watkins notes, "A 2022 federal inspector general report said audits “have highlighted widespread and persistent problems related to inappropriate denials of services and payment” by Advantage plans.

 

Open enrollment for Medicare Advantage plans runs through Thursday, Dec. 7. It will resume Jan. 1 and end March 31; for switching Advantage plans or going to original Medicare. 

Help with Medicare is available at Medicare.gov, 1-800-MEDICARE and the Kentucky State Health Insurance Plan office.