Nashville mayor weighs in on Vanderbilt, Humana contract dispute, urges negotiation
Clarification: In 2016 Vanderbilt University and Vanderbilt Medical Center became legally and financially separate nonprofit entities. An earlier version of this story failed to note this distinction.
Mayor John Cooper is urging Vanderbilt University Medical Center and the Medicare Advantage insurance provider, Humana, to settle a contract dispute that could affect plans carried by Metro employees over the age of 65.
At issue is the hospital's declared decision to stop offering Medicare Advantage plans through Humana and Wellcare of Tennessee, effective April 1. The health center is citing inadequate payments for medical services and has already begun notifying patients of its decision, said Vanderbilt spokesman Craig Boerner.
Such notices of contract termination are not uncommon in negotiations between hospitals and insurers before parties eventually come to terms.
Cooper's letter, dated Jan. 10, urged both sides to continue negotiations. Should negotiations fail, Cooper suggested that both parties allow for Metro government Medicare Advantage beneficiaries to continue to receive Vanderbilt services as an out-of-network provider.
"A decision to terminate participation in the plan could pose sudden, drastic, and potentially harmful consequences for our valued pensioners and dependents," Cooper wrote. " Moreover, termination could pose significant consequences for beneficiaries through Davidson County who are age 65 and over and rely upon Humana Medicare Advantage for their healthcare services."
The health center has created a website for Medicare Advantage patients affected by the changes (VUMCMedicareAdvantage.com) and a dedicated phone line for those who want to speak to someone: 855-429-2989.
It also released a statement explaining its reasoning behind the decision to drop Humana:
"The change is necessary because health systems like VUMC need to be paid fairly for services they provide and continue to contend with higher costs for personnel, supplies, equipment, and medications necessary to provide high-quality care," the statement read. "These factors, among others, have caused unprecedented cost increases. To ensure our mission, we must take this step."
Humana spokesman Jim Turner said Vanderbilt is seeking a 20% increase in payments for all treatments.
"Humana would like to retain VUMC as an in-network provider, and we hope to reach a new agreement with VUMC prior to April 1, 2023," Turner said in an emailed statement to The Tennessean. "But asking Humana and our Medicare Advantage members to start paying 20 percent more for all VUMC services is not acceptable."
Frank Gluck is the health care reporter 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: Nashville mayor weighs in on Vanderbilt, Humana contract dispute
