HCA Hospitals, Humana in Contract Dispute

Jun 8, 2015

Humana has sent letters to its Florida customers alerting them that as of July 10, HCA hospitals will no longer be part of the insurer’s network.  

When it comes to insurance disputes, this is the heavyweight division. Humana, based in Louisville, has close to 1 million Medicare patients in Florida plus hundreds of thousands of business and individual customers who sign up through insurance agents or the federal Marketplace for subsidized plans under the Affordable Care Act.

With 46 hospitals or surgery centers in Florida, HCA is by far the state’s largest for-profit chain.   If the contract between Humana and HCA ends, the shock waves will be felt statewide.  

Such letters usually turn out to be false alarms; insurers and hospitals usually reach agreement on a new contract in the nick of time.  The federal government requires that insurers send out the letters 30 days before a contract expires. And HCA spokeswoman J.C. Sadler said in a statement the company is "optimistic it will be worked out."

The Humana letters reassure members that their plan benefits remain the same, that the company has contracts with other hospitals and surgery centers. 

But just as patients have favorite doctors, physicians tend to use certain hospitals, so a change in the hospital network can force patients to make a choice to change doctors or risk paying out-of-network rates if they need hospitalization.

The dispute comes at a time when Humana is not talking.  The Associated Press reported Monday that Humana has gone into a deliberate period of silence until its second-quarter earnings report, scheduled for July 29. Its quiet time follows a run-up of the stock price following a Wall Street Journal article (paywall alert) on May 29 suggesting that Humana was exploring a possible sale of the company.

Among the suitors mentioned were Aetna and Cigna, although some have speculated that Anthem may be interested, as well. The Journal article said insurers are merging to give themselves increased leverage in negotiations with hospitals to hold down costs.

Humana sent letters to its members about the contract dispute with HCA hospitals on June 3.

Nashville-based HCA became the largest for-profit hospital corporation in the nation through consolidation.  One of the companies from which it grew was Columbia Hospital Corporation, founded in 1987 by Rick Scott, now governor of Florida.  

This dispute also comes at an awkward time for most Humana patients – the middle of the plan year for both its Medicare and Marketplace members.  Members cannot change plans at mid-year.

If there is no deal by July 10, the Humana letter says, some patients who are already undergoing treatment at an HCA hospital may continue to receive it at in-network rates if they receive Humana approval.

Humana’s letter says members who have questions can call 800-457-4708 Monday through Friday from 8 a.m. to 8 p.m.

A Humana-HCA rift may produce the most angst in Tampa Bay, where both companies command a large share of the market. HCA runs 22 hospitals and surgery centers in the three most populated counties of the metro area, Pasco, Pinellas and Hillsborough.  South of the Sunshine Skyway Bridge, HCA has another eight hospitals between Bradenton and Venice.

Other areas where HCA owns a large number of hospitals and surgery centers include the three big South Florida counties (Palm Beach, Broward, and Miami-Dade), where there are 21, and Jacksonville, where there are eight.

Carol Gentry is a special correspondent for WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.