More information

“Sit with someone who understands Medicare” was a pervading message at Thursday’s informational meeting about possible options for retired teachers in the wake of Hunt Regional Healthcare’s looming split with Humana.

“Sit with someone who understands Medicare” was a pervading message at Thursday’s informational meeting about possible options for retired teachers in the wake of Hunt Regional Healthcare’s looming split with Humana.

Two weeks ago, Hunt Regional mailed a letter to those who are covered under any of Humana’s medical insurance products, explaining that all agreements between the hospital and the insurance company would be canceled, effective Jan. 1, 2020.

According to the letter, administration at Hunt Regional decided to cancel all agreements with Humana because “Humana’s business practices include more frequent refusals to approve necessary services for patients, more frequent refusals to pay and delays in payment for services provided.”

Regardless of the reasons given in the letter, several of the 600 retired school employees in the community who are covered through TRS – whose insurance is through Humana – became concerned about Hunt Regional becoming an out-of-network healthcare provider for them.

On Thursday, seniors who receive Medicare coverage through TRS filled the meeting room of the Landmark on Lee Street to get updates on the decision and to learn more about their options after the split.

The meeting was conducted by staff with Cornerstone Senior Services and personnel with Hunt Regional Healthcare and Hunt Regional Medical Partners.

A topic of much discussion was TRS’s network coverage, which is described as letting “you see any doctor who accepts Medicare” regardless of if they are in or out of network, but the doctor also has to “agree to bill Humana.”

According to Katy Ridge with Cornerstone, even doctors who are within someone’s network are not required to see them.

“We had a lady that had Humana print a list of doctors that were in her network, but none of the local ones would see her,” Ridge explained. “She ended up having to go to McKinney.”

“Even if a doctor is in your network, they’re not required to see you.”

Ridge went on to recommend that people take several different factors into consideration when making decisions on their health insurance.

“You have to look at everything holistically,” Ridge said. “You have to think about which doctors you need, your benefits, your medication, and sometimes even your premiums, because sometimes the amount you save on the premiums you pay ends up benefitting you more overall.

“The best thing to do is sit with someone who understands Medicare and look at what all of your options are,” she continued. “It doesn’t have to be me. If you have a friend or a neighbor who works in dealing with Medicare, talk to them.

“In and out of network is just one of many factors to consider, just as deciding whether to stay with TRS or switch to a traditional Medicare Advantage plan.”

In addition to the advice given by Ridge, staff with Hunt Regional further elaborated on the reasons behind the decision to sever ties with Humana.

In light of Humana’s frequent refusals to approve necessary services for patients, frequent refusals to pay and delays in payment for services provided, Hunt Regional CFO Lee Boles said, “The decision was not made lightly … It took a disproportionate amount of effort to deal with Humana compared to other payers.

“For the last two years, we’ve spent a lot of time with attorneys, trying to reconcile … and we had a few good meetings when they’d send people from middle management to talk with us,” Boles added. “Things would feel good, and they’d leave like they really wanted to help make some changes, but I think it was like ‘trying to turn a battleship’ for them.”

Another factor in Hunt Regional’s decision was the fact that it is a property tax-supported entity.

“Humana is a business, and Medicare pays them to pay for your care,” Boles said. “So when they refuse to pay and we have to cover the cost, as a governmental authority with tax support, their refusals to pay and delays in payment make it hard on us because we have to keep our tax rate low.”

It was also mentioned at the meeting that discussions between Hunt Regional and Humana and between TRS and Humana are still underway.

“We have a proposal on their desk at Humana, so the ball is completely in their court. Humana made $5 billion in profits last year, so I think that can help us out a little,” Boles said. “But really, right now, we’re on the sidelines as Humana and TRS try to work out where they stand with each other.”

Despite the explanations, several of those in attendance expressed their disappointment in the decision and the precarious position it puts them in.

“You’re looking at this from a financial standpoint, but we’re looking at this from a humanitarian standpoint,” one attendee commented. “You’re talking about how the hospital can’t afford to keep them, but how are we supposed to afford what we need?”

Similarly, another resident said, “I’ve talked with someone with TRS, and from what I understand, I can either go to Sulphur Springs or Rockwall for an in-network hospital. I don’t want to go to Sulphur Springs or Rockwall, when I pay taxes for the hospital in Greenville.”

Throughout Thursday’s discussion, though, another point that was made repeatedly was that the split would have no effect on emergency care, regardless of if the patient is in-network or out-of-network. Hunt Regional and Humana’s parting of ways is supposed to only affect scheduled visits and elective services.

For those who missed Tuesday’s informational meeting about the termination of the contract between Hunt Regional Healthcare and Humana but would like to attend one, the meeting will be held again in Commerce, on Monday a 6 p.m., in the Community Room of the Hunt Regional facility at 2800 Highway 24.

Travis Hairgrove is a news reporter and features writer at the Herald-Banner and covers city government for many municipalities in Hunt County. To reach him outside of business hours, email THairgroveReporter@gmail.com.

Recommended for you