Vanderbilt, Humana resolve contract dispute impacting some insurance plans

Vanderbilt University Medical Center and Medicare Advantage insurance provider Humana have reached an agreement to continue providing in-network care for most Medicare Advantage patients, including nearly 2,000 Metro employees and retirees, Metro officials say.

The agreement is pending an amendment signature, according to an email sent to Metro Council members and the Metro Employee Benefit Board by Metro Human Resources Director Shannon Hall Monday evening. Impacted patients will be notified of the negotiation outcome via letter, Hall wrote.

Vanderbilt and Humana released a joint statement Tuesday morning confirming they had reached an agreement for Vanderbilt to continue providing in-network treatment to Humana beneficiaries with individual and group PPO insurance plans and to Humana’s commercial plan members. This deal includes retirees of the Metro Nashville Government.

But said they have not yet reached a deal to provide services to Humana’s Medicare Advantage HMO plan members, and to Humana’s Kentucky Medicaid members.

"As such, VUMC will be out of network for these members effective April 16," the statement reads. "Humana will be reaching out to its Medicare HMO and Kentucky Medicaid members to help them find new healthcare providers, to ensure they continue to have access to quality care through Humana’s remaining in-network providers."

Earlier coverage:Nashville mayor weighs in on Vanderbilt, Humana contract dispute, urges negotiation

Related coverage:'Obamacare' enrollments in Tennessee reach all-time high

For several weeks, a contract dispute between the health care provider and Humana left dozens of Metro employees over the age of 65 fearing they would be forced to change doctors this spring.

The hospital announced in January it would stop offering Medicare Advantage plans through Humana and Wellcare of Tennessee effective April 1, citing inadequate payments for services. Vanderbilt initially sought a 20% increase in payments for all treatments, but negotiations reached an impasse when Humana contended the raise was unacceptable.

Cooper urged Vanderbilt and Humana to continue negotiations in a Jan. 10 letter to protect around 2,000 Metro pensioners and their dependents. Metro Council unanimously passed a resolution advocating for a resolution and undisrupted service for Metro employees, pensioners and retirees on Jan. 17.

“After months of intensive conversation, I’m pleased that Humana and Vanderbilt University Medical Center have reached an agreement that allows Metro retirees and thousands of other Davidson County residents on the Humana Advantage PPO plan to continue receiving care from VUMC physicians," Nashville Mayor John Cooper stated Monday. "Nearly 2,000 former Metro employees would have been forced to change doctors next month had we not been successful at finding a way forward."

Under the agreement, patients carrying Humana commercial plans (including Metro employees and retirees) and patients in Humana's Medicare Advantage PPO individual and group plans will remain "in-network," according to Hall.

A Vanderbilt web page that was created in January to announce the severance with Humana and explain what affected patients should do remained up as of Tuesday. It includes a dedicated phone line for those who want to speak to someone: 855-429-2989.

Metro approved the use of Humana's Medicare Advantage plan for Metro pensioners and retirees in July 2021 with the understanding it would go into effect on Jan. 1, 2023. The transition early this year happened to coincide with the contract dispute between Vanderbilt and Humana.

The decision stemmed from ballooning unfunded health care costs for Metro pensioners at the time. The move was expected to shave roughly $1 billion off of a $4.3 billion balance of unpaid future payments and reduce Metro's annual operating costs by about $17 million.

Local union SEIU Local 205 supported the switch, which would keep costs for retirees the same or lower than past plans, despite some concerns from the Metro Employee Benefit Board, which ultimately voted in favor of the deal 6-4.

The dispute between Humana and Vanderbilt renewed discussion regarding Metro's 2021 decision.

In January, Hall told Metro Council members that the business decisions of Vanderbilt and Humana were "a separate issue than the transition of pensioners into the Metro Medicare Advantage plan."

District 27 Council member Robert Nash monitored the situation over the last several weeks as a local representative and an impacted retiree. As a former Metro Nashville Police Department commander, Nash is among those covered by the Medicare Advantage plan through Humana.

"To some of us who are very healthy right now, it would be an inconvenience (to lose in-network status) if we were seeing Vanderbilt, but we had people that were really in life-threatening conditions — heart transplant, kidney transplant patients and others that really needed that continuity of care, and some of that care was only available at Vanderbilt, so this is extremely important," Nash said. "Many of these people are getting up in age where they don't need the extra anxiety, so we're just very pleased that the parties were able to resolve this."

Cassandra Stephenson covers Metro government for The Tennessean. Reach her at ckstephenson@tennessean.com. Follow Cassandra on Twitter at @CStephenson731.

Frank Gluck covers health care for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.

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This article originally appeared on Nashville Tennessean: Vanderbilt, Humana resolve dispute impacting Nashville city employees