Baptist Health, out of Humana Medicare Advantage network since Sept. 22, is now in a similar dispute with insurer United Healthcare

By Heather Close Published October 10, 2023 FEATURED, HEALTH BUSINESS, HEALTH POLICY, YOUR HEALTH

Baptist Health, Kentucky’s largest hospital chain, is at odds with another major health insurer over payments for patients covered by its Medicare Advantage and group retiree plans.

“United Healthcare, the country’s largest insurer, told its Louisville-area Medicare Advantage members that its contract with Baptist will expire Jan. 1, and that they should look for new health-care providers to avoid paying higher ‘out-of-network’ costs for care at Baptist,” reports Chris Otts of WDRB.

The dispute “comes as the large nonprofit health system continues to remain at odds with insurer Humana Inc., which is also headquartered in Louisville,” Otts notes. “Humana Medicare Advantage plans have not included the Baptist Health Medical Group — Baptist’s physician practices — in their network since a contract between the two companies expired Sept. 22.”

United is “working hard” to keep Baptist in its network, the insurer said a Sept. 28 letter to insureds,” Otts reports. “A spokeswoman for Baptist declined to comment [but said] the health system plans to release more information next week. She was unable to say how many patients may be caught up in the dispute.”

Most Medicare beneficiaries are covered by Advantage plans sold by private companies. “The Advantage plans provide extra benefits like dental, hearing and vision coverage and sometimes even gym memberships or cash for groceries,” Otts notes. “But in exchange, seniors agree to be subject to restrictions like provider networks or prior authorizations. The situation with Baptist Health shows the disruption that seniors risk when they chose the Advantage plans, said Wendell Potter, a former executive at Humana.” Traditional Medicare has no such limitations.