WakeMed and Humana failed to reach an agreement on several Medicare Advantage Plan contracts, resulting in the contracts lapsing and WakeMed facilities becoming “out-of-network” for those insured by the PPO or HMO plan. The contract lapse does not affect state retirees who receive Humana insurance through the State Health Plan. Humana is making efforts to find new in-network providers for the impacted members while working towards a resolution with WakeMed.
WakeMed and Humana Contract Dispute Impacts Medicare Advantage Plan holders
WakeMed and Humana were unable to reach an agreement by their Monday deadline, leading to the lapse of numerous Medicare Advantage Plan contracts.
PPO or HMO insured WakeMed facilities will now be termed as “out-of-network”. An official representative for WakeMed could not provide the exact number of patients affected by this issue.
WakeMed spokesperson, Debbie Laughery reassured that the contract lapse does not affect state retirees. Patients who have Humana insurance through the State Health Plan will continue to be covered.
Humana is still in talks with WakeMed to find a resolution, the spokesperson added. Meanwhile, Humana will assist impacted members to find alternative in-network providers.
Humana had apprised members about this impending issue earlier this month, through a letter stating WakeMed may soon become out-of-network.
The negotiations failed as Humana’s high rate of health claim refusals and reluctance to set up dispute resolution systems regarding necessary care, according to a WakeMed spokesperson.
This dispute is one among several other high-profile insurance disputes in the Triangle this month. UNC Health and UnitedHealthcare are currently in contract negotiations, and ECU Health is also disputing with Humana.