Hospitals Dropped from Medicare Advantage Networks

Health News Florida has an interesting story about a dispute between Humana’s Medicare Advantage plans and a Miami Hospital and doctor network.  Medicare Advantage plans must control their costs, and when a doctor group or hospital requires payments that are too high, the Advantage plan has only one option:  Cut that hospital and doctor group out of its network.

Up to 100,000 patients remain in limbo following Humana’s announcement that it would no longer include Baptist Health South Florida hospitals in its provider network, the Miami Herald reports.

Baptist Health is the largest healthcare provider in the region, boasting seven hospitals in Miami-Dade and Monroe counties and more than 30 outpatient facilities in Miami-Dade and Broward. But Humana has clout, too, with the largest Medicare Advantage plan membership in the state.

Insurance agents say Baptist Health’s prices have long been higher than competitors’ but since it requires contractors to keep them secret, it has not been widely known outside the industry. Only an insurer with a large market share could push back.

A similar struggle took place in Tampa Bay in 2012 between the giant health system BayCare and United Healthcare. During the dispute, both sides took out newspaper ads and sent letters to patients; BayCare even suggested that United members might want to switch insurers. Meanwhile, nearly a half million patients were frightened about whether they’d lose their doctor or hospital. In the end, BayCare and United  signed a five-year contract.

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