Humana contract negotiations fail with local hospital

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The chief financial officer of the Clark Fork Valley Hospital (CFVH) had officially advised those patients under the previous Medicare Advantage program that the hospital had been unsuccessful in recent negotiations.

“We know that there is a continuing high level of interest in the community concerning Humana Medicare Advantage after Blue Cross Blue Shield of Montana’s withdrawal from the local market for their Medicare product. I am writing to provide our patients with the latest information I have regarding this situation. I am sorry to report that CFVH has not yet been successful in negotiating a contract with Humana,” said Carla Neiman, Chief Financial Officer, for CFVH.

She added at present, they were continuing negotiations with Humana for a Medicare Advantage contract that would allow the hospital and clinics to be considered participating providers for their Medicare product.

“We have been engaged in this process with Humana since learning that they were marketing their plan in Sanders County last October. We do not have an indication at this point whether we will be successful in reaching an agreement that will allow us to participate with Humana during 2018,” she added.

Their intentions are to have a final decision and announce it to the wider community by Jan. 31. Knowing a definitive answer as to whether or not the CFVH will have a contract with Humana for the coming year.

“We are aware that those individuals who were previously covered by BCBS Medicare have until Feb. 28 to make a final decision on Medicare coverage for 2018 and we want to ensure that you have adequate time to make a decision with clear knowledge of our status as a provider with Humana,” she said.

Neiman expressed to those effected that if they had already enrolled in the Humana HMO Plan (Humana Gold Choice HMO) they needed to be aware that should you seek services at CFVH or one of their clinics you are currently out of network and have no Medicare coverage for non-emergent services.

She expressed the only exception is emergency services only as defined by Humana themselves.

Neiman explained in the official letter that as per her previous outlined letter to those affected because of previous Medicare coverage changes that the options for their (CFVH Medicare patients) who where previously insured by Blue Cross Blue Shield can still be viable options for coverage.

“You can choose Traditional Medicare and a supplement to cover the coinsurance and deductibles that Medicare does not pay. Remember, the Humana Medicare Supplements are 100 percent fine,” she said.

“If you cannot afford a supplement, you are likely eligible for Clark Fork Valley Hospital’s Financial Assistance Program which offers forgiveness of up to 100 percent of the balance after Medicare depending on your income. There are also state programs which will assist with supplemental coverage and pharmacy coverage for low income seniors. If you need help evaluating your options, please contact the Area VI Agency on Aging. They have unbiased SHIP counselors who are very knowledgeable and can help,” she added.

Neiman advised that the CFVH will be participating in meetings with the Area VI Agency on Aging at the local Senior Centers in January.

Their staff will be available to answer questions and provide information about our Financial Assistance Program.

“We know that you have a choice of health care providers, and we value our relationship with all our patients. As we have seen, insurance providers will come and go, but Clark Fork Valley Hospital is committed to caring for the residents of Sanders County and we will always be here to serve our community. We sincerely regret this situation which has developed beyond our control and we will continue to do our best to address it,” said Neiman.

Tentative Schedule for Senior Center Meetings with Agency on Aging:

Wednesday, January 24, Plains Senior Center 11:45 a.m.

Wednesday, January 24, Heron Senior Center 5:30 p.m.

Thursday, January 25, Tribal Nutrition Center, 11:30 a.m.

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