Humana, Florida’s largest Medicare HMO company, has a lot of market muscle. This year, it used that muscle to dump many Gold Plus Plan dermatologists in Florida soon after the ink was dry on their contracts.
It shifted thousands of patients – along with financial risk for their skin treatment – to a chain of clinics run by a company based in Orlando, Advanced Dermatologyand Cosmetic Surgery.
The dermatologists accuse Humana of “bait-and-switch” by changing their network right after Medicare sign-up season ended. They’re encouraging Humana customers to bolt during the current open enrollment season.
“Switching your physician without your knowledge or consent is an outrage. But you don’t have to take it,” says an open letter to seniors posted online by theFlorida Societyof Dermatology and Dermatologic Surgery.
The Medicare Rights Center says such contract changes are legal. Florida physicians say, however, that companies normally wait until the end of a contract to make major network changes.
The tussle over dermatology is about more than the survival of private practice and doctors’ incomes. It raises questions about the rights of patients in HMOs once they are locked in.
Law 'needs to be changed'
“If you’re going to change providers, you should offer members an out” of the plan, said Laura Richards, practice manager at New Image Dermatologyin New Port Richey, which lost more than 500 Humana Gold patients. “That’s a law that needs to be changed.”
Humana won’t discuss financial details of its contract with Advanced Dermatology and Cosmetic Surgery, citing confidentiality, but said the timing was coincidental.
“Humana’s network contracting strategy with hospitals, physicians and specialists is based on business needs and a 52-week calendar,” wrote Dr. Scott Latimer, Central Florida market president for senior products. “As the needs of our business warrant, we make network decisions all year round. “
Some patients who were switched to Advanced Dermatology clinics say they were cared for by physician assistants or nurse practitioners, and were referred to physicians only if there were problems. It is not clear how many of the company's 50-plus clinics have physicians on site full-time, but some don't.
For example, as the website shows, Dr. Steven Glanz, who has a pathology lab in Delray Beach, is also listed as the physician at Advanced Dermatology clinics in Temple Terrace and Clearwater, hundreds of miles away. He reportedly commutes among the offices. A call to Glanz was referred to the company headquarters.
Health News Florida left phone messages for three top officials of Advanced Dermatology and Cosmetic Surgery on Monday, but no one from the company responded.
'Totally jerked around'
Some skin-cancer patients who were unwillingly shifted to the clinics say they will indeed switch plans.
“I’ve been totally jerked around by Humana,” said Peter Rummell, 75, who has been under the care of St. Petersburg dermatologist James Spencer for many years. He said he signed up for the Gold plan last year only after being assured by the Humana agent that Spencer was in the network.
That was true – at the time of enrollment. The situation changed a few weeks later. Since then, Rummell said, he has been billed more than $1,000 for skin biopsies because he didn’t go through the Advanced Dermatology clinic.
Sue and Larry Navage of Pasco County also felt cheated after Humana dropped their long-time skin-cancer specialist, Michael A. Myers of New Image Dermatology. Sue Navage, a melanoma survivor, says she explicitly asked about continuing with Myers when she signed up for Humana Gold last year.
A few weeks later, when Myers and his colleagues were dropped from the Humana Gold network, “we were just shocked,” she said.
Larry Navage, who has a squamous-cell spot near his temple, had to see a nurse practitioner before getting a referral to a physician, and then had to drive to Spring Hill from Hudson to see a surgeon, Sue Navage said.
So far he’s had four appointments, at $25 co-pay each time, and still hasn’t had the surgery, she said. It’s hard for a teacher to take off so much time, she said, and “very inconvenient.”
Myers always took off their skin cancers as soon as he found them, she said. But it’s not just his technical expertise she misses. “When you have cancer, you want to go to someone you know,” she said.
Medicare plans’ 2012 open-enrollment season, which began Saturday, will run through Dec. 7.
--Health News Florida is an independent publication dedicated to journalism in the public interest. Questions or comments can go to Editor Carol Gentry at 727-410-3266 or Carol.Gentry@HealthNewsFlorida.org.
