Humana

[somarco]

You are playing with fire.

Sometimes you can get away with it, but if they decide to pounce prepare to spend a bunch of $$$ in legal fees.

Your choice.

 

[agentjhc]

I would say a few here and there no big deal, a wholesale migration or a large # no so much.

 

[Naturalstateofmind]

Sorry I do not check this on a daily basis so I haven't been keeping up with answering all questions.
First of all I was not a career agent on staff with this company. Instead, a direct independent with a modified contract to receive hierarchy on leads and a few other benefits they offered.
Last year Meca contracts were amended from totally exclusive to where we could contract and market other plans (if we chose to) thru an approved fmo. (Non compete terminated at that point) At the time I only picked up one other company to market in an extremely rural area.
The decision this year by the hospital mentioned in the initial post came very unexpected and has left not only me but almost all other agents in our area scrambling to come up with a game plan. I have been in contact from the very beginning with the company contracting department. I recieved an amended contract that allows me to continue to receive payment in my book of business but releases me to where I can use the FMO of my choice to contract with any carriers of my choice. After having the contract reviewed by legal counsel I signed it and returned to them. Once that was processed I began contracting with the other fmo. Now it's looking like this may turn into a plan exit anyway.
I've burned no bridges and am actually planning events to assist any leads the company continues to send me as they have recently asked that I do.

 

[wehotex]

I've been what Humana considers a MECA (Medicare exclusive contracted agent) for about 3 years now and so I have approx. 400 clients with them who live in the 5 counties around me. Recently the only hospital within those five counties has decided that they are no longer going to accept any of Humana's plans, therefore I have moved my contracting with Humana from captive to independent. I'm in the process of getting appointed with all the other carriers through an FMO so that I will be able to service all my existing book of business. Busy AEP to say the least. Right now Humana is last on my list of doing certifications for. I almost wish this had been a plan exit just so I could have switched many of my clients to a guaranteed issue med supp.

That's horrible!!! Any chance of renegotiating their contract before AEP? How does a large company like Humana let this happen? Is your area predominately HMO or PPO?

 

[somarco]

Losing a major hospital in a rural area happens. Dalton and Albany Georgia have had disputes with BX and refused to negotiate a PPO deal with the carrier. If the carrier wants to play in that market they need to increase their reimbursement.

Humana, like several other MA carriers, is moving toward more HMO contracts, especially in rural areas. Expect to see more issues with tiny networks going forward.

 

[Naturalstateofmind]

That's horrible!!! Any chance of renegotiating their contract before AEP? How does a large company like Humana let this happen? Is your area predominately HMO or PPO?

Negotiations are over unfortunately in this situation. It's a shame that one provider facility carries all the weight in these areas, and how they decide to spin the Press release is what most consumers take as biblical. Most of my clients are on an HMO and from what I'm seeing people on the PPO will still be in a terrible situation if they are seeing out of network providers.

 

[plannerman]

I just heard from a prospect that Humana lost Baxter County hospital in Arkansas. Not my market but maybe it will help someone.

 

[MedicareAgent]

I just heard they are having issues in Brevard county in Florida !!

 

[somarco]

They might need to sell a bit sooner.