NMHS and Humana Cut Ties

North Mississippi Health Services (NMHS) and Humana officially cut ties Jan. 1, 2019, as the provider and insurer failed to reach an agreement on a Medicare Advantage (MA) contract.

Since Jan. 1, 2019, our healthcare facilities (hospitals, imaging and surgery centers) and employed physicians are “out of network” with Humana Medicare Advantage.

This contract does not impact Humana Commercial group members through employer sponsored health plans in the region. The “out-of-network” status due to this contract termination is specific to individuals who have purchased a Humana Medicare Advantage Plan.
NMHS notified Humana that it would not renew the Medicare Advantage agreement under the existing terms because an unusually large number of claims denials have occurred with NMHS providers. The denial issue, coupled with an egregious amount of administrative tasks and costs tied to the prior authorization and reimbursement process for Humana members, led to our business decision to terminate the contract.

Impact of the Change to Out-of-Network Status

With NMHS remaining as an Out-of-Network provider, Humana MA members will not be able to schedule elective procedures at NMHS locations or with NMHS providers without an approved waiver from Humana verifying “in network” benefits payment.

Waiver Situations

As such, it is very important that the Humana MA members understand that the obligation for providing any requested information to Humana will be the responsibility of the member. NMHS will no longer be in a position to assist in this documentation requirement process.

Members requiring assistance in completing a Waiver will be routed to Humana Customer Service.

What Options Exist for Medicare Members in the Community?

With NMHS providers exiting the Humana Medicare Advantage PPO network, members are faced with two choices:

  1. Drop their coverage with Humana and enroll in traditional Medicare and add a Medicare Supplement, plus consider adding a Part D prescription drug plan.
  2. Find another provider who participates in the Humana Medicare Advantage PPO network.

NMHS is a Medicare provider and accepts a wide range of Medicare Supplement plans. A listing of Medicare Supplement plans is located on the Mississippi Department of Insurance website www.mid.ms.gov.

When’s the Medicare Open Enrollment Period?

Every year, Medicare’s open enrollment period is Oct. 15-Dec. 7.

What is the Medicare Open Enrollment Period?

Medicare health and drug plans can make changes each year—things like cost, coverage and what providers and pharmacies are in their networks. Oct. 15 to Dec. 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

Where can people find Medicare plan information or compare plans?

1-800-MEDICARE or Medicare.gov.

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