For the second time in just over a week, another major Ohio health care network is warning patients with Humana Medicaid and Medicare Advantage plans that they could soon be out of network.
On Tuesday, Mercy Health announced that the system and Humana have until Dec. 1 to reach a new agreement.
“We recognize that patients who rely on Managed Medicaid or Medicare Advantage often face unique challenges and may be among the most vulnerable in our communities,” said Dr. John Luellen, president of Mercy Health–Ohio. “When reimbursement rates are not sustainable and claims are frequently denied, it creates uncertainty and barriers to care for these patients and their families. We remain committed to resolving these negotiations thoughtfully and protecting our patients from any gaps in access to care.”
Last week, Kettering Health said it will not renew its contracts with Humana and Devoted Health at year’s end, citing persistent problems such as denied claims, reduced payments, and heavy operational burdens.
Mercy Health raised similar concerns in a statement posted Tuesday:
“Unfortunately, what Humana pays our doctors, nurses, and caregivers is not adequate to cover the cost of providing safe, quality care. By failing to offer sustainable reimbursement rates and address persistently high claims denial rates, Humana may be putting your in-network access to Mercy Health facilities and providers at risk.”
Both Mercy Health and Humana have not yet provided additional comments.
Humana representatives previously said negotiations with Kettering Health were ongoing.
The news has left some patients anxious, including Don and Jackie Nowak of Beavercreek. Both in their 70s, the couple has Humana insurance and sees doctors across multiple networks.
Don’s primary doctor and three specialists are with Kettering Health, while Jackie receives care at The James Cancer Hospital. They also visit Premier Health and independent physicians.
“What we discovered with the Humana plan is everyone takes it,” Don said. “The idea of having to find and build relationships with all new doctors is not something we want to face. I hope these negotiations are just routine talks.”
“I understand Kettering’s position. I understand Humana’s position. It puts us in the middle,” he added.
Kettering Health operates 14 medical centers and over 120 outpatient facilities in western Ohio, including the Kettering Physician Network with more than 700 board-certified providers.
Mercy Health runs 23 hospitals and hundreds of clinics, urgent care, and medical centers across Ohio and Kentucky, including in Springfield, Butler, and Warren counties.
Humana Inc., based in Louisville, Kentucky, is a Fortune 500 health care company with more than 14 million members nationwide, specializing in Medicare Advantage, Medicaid, group health insurance, and specialty services.
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