Consumers are being forced to deal with the fallout as one of the biggest hospital chains serving Palm Beach County, Tenet, is telling customers it is no longer in the network of one of the biggest insurers, Humana.
“We are now out of network with Humana,” said a Tenet mailer received by a West Palm Beach customer Thursday. “Despite our repeated efforts to find common ground, Humana made it clear they would rather compromise your access to our doctors and hospitals rather than work together to complete a contract.”
For its part, Humana portrayed Tenet as the party cutting ties.
“In the interest of our plan members, Humana has tried for many months to keep Tenet as a preferred medical care provider in the Humana network,” Humana spokesman Mitch Lubitz said. “Tenet unilaterally terminated its agreement with Humana for Medicare Advantage, commercial, Medicaid, individual major medical plans offered through the public exchange and TRICARE product offerings as of Sept. 30, 2016. Humana is still in negotiation with Tenet on a new contract, but so far Tenet has not agreed to terms that are fair and reasonable for our health plan members and customers.”
Affected are 10 Tenet hospitals in the region including St. Mary’s Medical Center and Good Samaritan Medical Center in West Palm Beach, Palm Beach Gardens Medical Center, Delray Medical Center and West Boca Medical Center.
Accesss to emergency care is not affected, the Tenet mailer said, and “continuity of care” benefits may be available for an ongoing treatment or scheduled procedure. But out-of-network benefits now apply in most cases — meaning the consumer generally pays much more out of pocket.
To find out more or to see if your doctor is affected, Tenet advises checking www.ProtectMyAccess.com or call (800) 290-0836.
Humana’s statement goes on to say “we strive to provide access to a wide range of health care facilities, but at the same time, we must ensure that our contracted facilities provide quality, cost-effective care, to keep health coverage and out-of-pocket costs as affordable as possible for our health plan members.”
The insurer said it has “provided timely and regular communications to our members affected by the Tenet network contract termination. We have shared information with these members on alternative hospitals, primary care doctors and specialists in our health care provider network.”