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Patients with Humana insurance plans lose in-network coverage for Baptist Health Medical Group

A red stethoscope is shown coiled up, with a $100 bill in the background.
Starting Friday, local patients with certain Humana health insurance plans may have to pay higher out-of-pocket costs if they see a Baptist Health Medical Group provider.

Baptist Health and Humana faced a deadline Friday to reach an agreement for continued in-network health insurance coverage.

Baptist announced Friday that they did not succeed in negotiations with Humana, so there will be immediate changes for many patients.

Specifically, Baptist Health Medical Group no longer qualifies as an in-network provider for Humana’s Medicare Advantage plans as well as its commercial health insurance plans, which workers get through their employer.

Because of that, patients insured by Humana could get charged higher out-of-pocket costs if they see a clinician with the Medical Group, which includes over 1,100 doctors and advanced practice clinicians in Kentucky and Southern Indiana.

For a lot of local patients, that means they will need to find other in-network health care providers.

Some patients might be eligible for Humana to keep covering their treatment by a Medical Group physician, either at in-network rates or pricier out-of-network rates. They can find out by contacting their insurer.

In general, Baptist recommends people contact Humana directly to learn how they are affected by this change in policy because coverage rules vary depending on the particular insurance plan someone has.

Baptist’s hospitals are staying in-network with Humana. That includes inpatient services for physical and occupational therapy.

However, Baptist said various nonemergency services provided at their hospitals by a clinician with the Medical Group will still be out-of-network.

Baptist noted that insurance companies, including Humana, have to cover emergency services at in-network rates. So anyone with a medical emergency should go to the closest emergency room.

In a prior statement to LPM News, Humana said Baptist gave notice in June that it intended to end the Medical Group’s existing agreement for Humana’s Medicare Advantage and Commercial Group members.

Both Baptist and Humana told LPM News in late August that they were in negotiations to try to secure a new contract.

In a statement Friday, Baptist said, “As caregivers, nothing is more important than ensuring our patients have access to the care they need, when they need it. We understand this process has been frustrating for our community, but we will continue to advocate for those we serve.”

Patients can get more information about how this policy change could affect them on Baptist’s website.

On the site, Baptist addressed a question many patients may have: How long will this situation last?

Baptist’s answer: “It is an ongoing process. We remain committed to working with Humana in good faith and will continue to advocate in the best interest of our patients.”

Morgan is LPM's health & environment reporter. Email Morgan at mwatkins@lpm.org.

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