Patients are advised to explore new coverage options amid administrative challenges
The healthcare environment in Bismarck, North Dakota, is experiencing a notable shift as local hospitals, including Sanford Health, announced plans to stop accepting Humana Medicare Advantage plans effective January 1, 2025. This decision is part of a rising trend seen across the United States and is motivated by ongoing administrative difficulties that have resulted in delays in patient care and denials of coverage. The North Dakota Insurance Department is urging affected individuals to explore new Medicare plans during the current open enrollment period, running from October 15 to December 7.
Sanford Health has informed its patients that it will end its contract with Humana Medicare Advantage on December 31, 2024. While this change will not impact all Medicare Advantage plans, it reflects a broader trend observed in many health systems nationwide. The decision is primarily driven by persistent problems related to coverage denials, scheduling delays, and the financial pressures these issues place on patients.
In a statement, Martha Leclerc, vice president of corporate contracting for Sanford Health, acknowledged the difficulty of this choice but emphasized its importance for patient care. Despite efforts to work collaboratively with Humana over the years, Sanford Health has encountered increasing challenges that restrict patient access to essential services. This situation ultimately led to the conclusion that terminating the partnership with Humana Medicare Advantage is essential for the well-being of their patients.
Effects on patients and alternatives
As the deadline approaches, individuals currently enrolled in Humana Medicare Advantage are encouraged to examine their coverage options during the open enrollment period. This is a critical time for beneficiaries to assess alternative plans that will best suit their healthcare needs in the coming year. New plan information was made available on October 1, enabling patients to make informed decisions regarding their future coverage.
Patients should be aware that while certain healthcare providers may no longer be in-network for Humana Medicare Advantage plans after January 1, 2025, care will still be available to all patients, regardless of their insurance coverage. However, individuals who opt to remain with their Humana plan may incur higher out-of-pocket costs, as these providers will be considered out-of-network for them. To avoid unexpected expenses, beneficiaries must confirm whether their current healthcare providers are included in their chosen plans for the upcoming year.
The importance of reviewing coverage plans
This situation is not unique to Bismarck; healthcare systems across the nation are reassessing their contracts with Medicare Advantage providers due to similar administrative hurdles. Many hospitals have reported difficulties in securing timely payments from insurers and high rates of denial for prior authorizations, prompting them to reconsider the feasibility of continuing partnerships with specific plans. A survey conducted by the Healthcare Financial Management Association revealed that a substantial number of health system CFOs are contemplating discontinuing contracts with one or more Medicare Advantage plans soon.
For individuals navigating this change in their healthcare options, the urgency of reviewing plans cannot be overstated. It is advisable for patients to consult with their healthcare providers and insurance representatives to fully understand the implications of this decision and to explore available coverage alternatives.
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