Vanderbilt Health to drop some Medicare Advantage plans

NASHVILLE, Tenn. (WSMV) - Vanderbilt University Medical Center announced it would no longer accept specific Medicare Advantage plans.

Vanderbilt Health ended participation with Humana and Wellcare of Tennessee Medicare Advantage plans. The change goes into effect April 1, 2023.

In an institutional statement, the hospital said:

“Vanderbilt University Medical Center (VUMC) has made the difficult decision to terminate its participation with specific Medicare Advantage plans offered through Humana and Wellcare of Tennessee, effective April 1, 2023. We have begun notifying patients insured through these plans.

“The change is necessary because health systems like VUMC need to paid fairly for services they provide and continue to contend with higher costs for personnel, supplies, equipment, and medications necessary to provide high quality care. These factors, among others, have caused unprecedented cost increases. To ensure our mission, we must take this step.

“Affected patients can learn more at a dedicated website or by calling our patient assistance line at 1-855-429-2989.”

Vanderbilt University spokesman Craig Boerner told WSMV4 the hospital would “continue to be willing to negotiate reasonable rates with Humana.”

However, a statement from Humana to WSMV4 said:

“On Dec. 21, 2022, Vanderbilt University Medical Center, together with its associated physician, ancillary centers, and affiliates (collectively VUMC) notified Humana of VUMC’s intent to terminate the existing provider contracts between Humana and VUMC, effective April 1, 2023. VUMC indicated that it would agree to a new contract only if Humana will start paying 20% more for all services VUMC provides, starting April 1. Although your note to Humana this afternoon indicated that VUMC is ‘willing to negotiate reasonable rates with Humana,’ Humana has attempted to negotiate – but the message we have received from VUMC is that they are unwilling to discuss a new rate that is anything less than a 20% increase.

“Humana would like to retain VUMC as an in-network provider, and we hope to reach a new agreement with VUMC prior to April 1, 2023. But asking Humana and our Medicare Advantage members to start paying 20% more for all VUMC services is not acceptable.

“We understand that changes regarding one’s healthcare can be difficult. If we are unable to reach a new agreement, we will work with our members to help them transition to other medical facilities and doctors. Humana maintains a large network of hospitals, physicians and specialists in the Nashville area. Also, there may be circumstances where members can continue care with VUMC for a specified time for continuity-of-care reasons. We encourage our members to call Humana Customer Care if they need personal assistance.”

This is not the first time Vanderbilt alerted patients to a potential drop in coverage. There was a similar incident with BlueCross Blue Shield in 2015 that eventually was worked out.

On Friday, Jan. 13, Wellcare also gave the following statement:

“At Wellcare, we are committed to ensuring our members have access to high-quality care and services, including a robust network of providers that meets or exceeds regulatory standards.

We are disappointed that an agreement has not been reached with Vanderbilt University Medical Center (VUMC), which issued a notice of termination of its contract with Wellcare, effective April 1, 2023.

We value our longstanding partnership with VUMC and want to reach an agreement that compensates the health system fairly. However, VUMC’s rate demand – which is as much as 25% higher than our current agreed upon rates, significantly higher than Medicare rates, and significantly higher than rates we are paying any other provider in the state – is clearly not in the best interest of our members or the local communities we serve.

Wellcare hopes to reopen discussions with VUMC in order to negotiate a new contract based on reasonable rates. If that is not possible, we are taking all steps necessary to mitigate the impact of a network change on our members and have a comprehensive process in place to transition them to alternative providers in the Wellcare network. We will work diligently to ensure the transition to new providers is as seamless as possible, so our members do not experience delays in receiving the health services they need.”

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