Piedmont Hospital Splits with Humana Medicare Advantage

[somarco]

Despite repeated attempts, Piedmont has been unable to reach a resolution with Humana on several aspects of care. Therefore, effective September 7, 2023, we are terminating our hospital agreement with Humana’s Medicare Advantage (MA) Plan.

Piedmont patients covered by Humana’s Medicare Advantage PPO Plan will continue to have coverage through their out-of-network benefits. Any prior authorization requirements by the plan will still be applicable.

[EXTERNAL LINK] - Piedmont & Humana’s Medicare Advantage Plan | Piedmont Healthcare

 

[goillini52]

Despite repeated attempts, Piedmont has been unable to reach a resolution with Humana on several aspects of care. Therefore, effective September 7, 2023, we are terminating our hospital agreement with Humana’s Medicare Advantage (MA) Plan.

Piedmont patients covered by Humana’s Medicare Advantage PPO Plan will continue to have coverage through their out-of-network benefits. Any prior authorization requirements by the plan will still be applicable.

[EXTERNAL LINK] - Piedmont & Humana’s Medicare Advantage Plan | Piedmont Healthcare

Do you think MA would cover this?

 

[AgentGeneral]

The iTit will cost about what DME bra with one insert costs. But darn it the hospital/surgical co pays and the rest might be a problem.

Just made me think of an appointment i had years ago for a problem with claims on BCBS. Sat at a home at clients table that i had for a few years and watched them argue about why bcbs paid for the husbands penile implant but not the wifes bladder ablasion. I was flabbergasted. Yep in their early 60s, this was 2008.. On the old BCBS individual plans. Unreal. It got fixed but I was in shock that bcbs paid for the 16k pump implant with not many questions. You never know what you'll see out there.

 

[straightnochaser]

Despite repeated attempts, Piedmont has been unable to reach a resolution with Humana on several aspects of care. Therefore, effective September 7, 2023, we are terminating our hospital agreement with Humana’s Medicare Advantage (MA) Plan.

Piedmont patients covered by Humana’s Medicare Advantage PPO Plan will continue to have coverage through their out-of-network benefits. Any prior authorization requirements by the plan will still be applicable.

[EXTERNAL LINK] - Piedmont & Humana’s Medicare Advantage Plan | Piedmont Healthcare

Did you click the link?

 

[Truce]

It's true that these contract disputes are usually resloved. It's also true that medicare eligibles can choose to have their medical care delivered in a way that bypasses these annual pissing contents between providers and insurers.

Last week I left a conference where the reps from all the local MAPD carriers took turns trading barbs about the local hospital systems that are/aren't in their competitor networks this year. It just seemed....low brow.

I am glad people have a choice to operate above that level....IF they want to.

 

[margostl]

Important Update: Humana and Piedmont reach a new agreement and Piedmont will remain in-network for all Humana Medicare Advantage products!
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Rusty Lamb
Tue, Sep 12, 8:53 PM (6 days ago)

to

Partners,



We are excited to announce that Humana and Piedmont have reached a new agreement, extending our relationship. All Piedmont facilities, including Piedmont hospitals, inpatient and outpatient facilities, remain in-network for all Humana Medicare Advantage products.



Services received at a Piedmont facility, regardless of the date of service, will be treated as in-network.


Please feel free to share this information with your members and prospects. We look forward to another great AEP and appreciate your partnership!


Sincerely,


Your Georgia Broker Relationship Management Team



David “Rusty” Lamb

 

[somarco]

5 day blackout period . . . which often happens, but still creates anxiety for seniors (especially) when they have upcoming, scheduled hospital tests/procedures. Same is true for hospital owned medical practices who WILL refuse patient appointments as long as the contract is in limbo.

Easy to be dismissive of this situation when it is not your ox that is being gored . . . but your clients definitely feel differently about this.

Ongoing negotiations is not just a "pissing match"

 

[goillini52]

The iTit will cost about what DME bra with one insert costs. But darn it the hospital/surgical co pays and the rest might be a problem.

Just made me think of an appointment i had years ago for a problem with claims on BCBS. Sat at a home at clients table that i had for a few years and watched them argue about why bcbs paid for the husbands penile implant but not the wifes bladder ablasion. I was flabbergasted. Yep in their early 60s, this was 2008.. On the old BCBS individual plans. Unreal. It got fixed but I was in shock that bcbs paid for the 16k pump implant with not many questions. You never know what you'll see out there.

I guess you have to have an implant in each Tit if you want stereo.

My uncle had one of those implants. He was 80 when he died....with a big smile on his face.

 

[goillini52]

View attachment 10260
Rusty Lamb
Tue, Sep 12, 8:53 PM (6 days ago)

David “Rusty” Lamb

Rusty Lamb, sounds like a kinky old porn star.

 

[somarco]

Rusty Lamb, sounds like an kinky old porn star.

You must be thinking of his evil twin, Rusty Limp