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Humana Medicare patients hit by contract dispute

Medicare patients cling to their doctors the way NRA members cling to their guns. It’s risky to take them away.

Nevertheless, that’s what a Humana contractor is doing to 7,000 Medicare Advantage plan members who get their primary care from University of Florida Physicians in Jacksonville.

Those 74 practitioners will be dropped from Humana’s Medicare network as of Aug. 31, the company and UF confirmed on Wednesday. Because Medicare enrollees are in the “lock-in” period until the end of the year, they can’t switch plans, so they must change doctors.

Richard Travers, a member of Humana Gold Plus, vows to keep seeing Dr. Susan Hoffman, paying out of pocket. He said, “I will not give up my doctor for anything.”

Hoffman and her PA, Michael Diana, have followed Travers closely for seven years – through the death of his wife, depression, diabetes, high blood pressure, and spine surgery.

“They know me like a book,” said Travers, 72. “They’ve got it all under control for me. I can’t afford to go to somebody strange who’s appointed by my insurance without my permission.”

Humana sent letters out to the affected members on Wednesday, said spokesman Mitch Lubitz. “We’re reassuring our members this week that there will be no disruption in their health insurance coverage or benefits during the transition, and that we have extensive alternative (primary care physicians) in our Jacksonville Medicare Advantage provider network.”

By the time the letters went out, however, some members had already heard the news from their own doctors.

The two-month notice Humana members are getting is double the requirement of the Centers for Medicare and Medicaid Services, said spokesman Tony Salters. Still, he said, CMS doesn’t like to see the disruptions.

“While we do not have the authority to prohibit mid-year network changes, we strongly discourage (it),” Salters said.

“CMS closely monitors these situations to ensure that plan enrollees continue to have adequate access to plan-covered services and the continuity of care is maintained,” he said.

The contract that is ending is actually between UF Physicians and a Humana contractor, MCCI Medical Centers. The Miami-based Medicare Service Organization handles primary care for several insurers, covering all services for a fixed per-member, per-month fee.

MCCI will open four new state-of-the-art primary care centers in the Jacksonville area in July to serve Humana Medicare Advantage members, said MCCI Vice President Debbie Finnel. The staff-model HMOs offer not only the best of medical care but also immediate service from a human – not a machine – when a patient calls in, she said.

UF Physicians is a fine organization, she said, but “sometimes relationships just don’t work,” Finnel said.

The reason it isn’t working, said UF and Shands Health Care’s Vice President for Managed Care Michael Lawton, is that MCCI wanted to change the contract and pay “significantly less money.”

Bound by confidentiality agreements, Lawton declined to talk about the size of the cost reduction that MCCI wanted. Humana and MCCI also declined to talk about that.

Finnel said that MCCI will give the Humana Medicare members “kid-glove” treatment to make sure they’re happy.

“Any change is stressful for seniors,” she said. “If they’ll give this a chance they’ll be excited about the kinds of services they receive at our facility.”

Humana Medicare Advantage plan members in the Jacksonville area who have questions or concerns about the Shands-UF change can call Humana from 8 a.m. to 5 p.m. Monday through Friday at 904-376-1234.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.