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Humana, HCA on brink of contract saga

Insurer sent letters to warn of potential changes

If Humana and Hospital Corporation of America cannot negotiate their contract by July 10, HCA will no longer be an in-network provider for hundreds of thousands of Humana customers in Florida, reported WGCU.org.

The Louisville-based insurer has nearly 1 million Medicare patients in Florida, while HCA is the largest for-profit hospital chain in the state, with nearly 46 hospitals or surgery centers.

Fourteen HCA hospitals rank among the 50 with the largest cost-to-charges markups in the United States, FierceHealthFinance previously reported. High markups can give hospitals greater leverage with insurers in price negotiations, which can contribute to higher premiums and increased overall spending.

Humana--which sent letters to its Florida customers 30 days before the contract's expiration, per federal government protocol--told members that their plan benefits remain the same and reassured them that the insurer has contracts with other hospitals and surgery centers.

But the potential contract saga comes during a critical time for most Humana members. It's the middle of the plan year for both its Medicare and Marketplace beneficiaries, meaning members cannot change plans mid-year, noted the article.

Should July 10 roll around with no deal, Humana told members undergoing treatment at an HCA hospital that they may continue to receive in-network rates if they receive approval from the insurer.

Even though HCA spokeswoman J.C. Sadler said the company is "optimistic it will be worked out," and that letters to members tend to be false alarms, a Humana-HCA showdown may cause some major drama in the state, since both companies command large share of the market, noted the article.

Humana did not comment on the contract dispute, which surfaced just days after Humana issued an 8-K filing to relay that it will enter a quiet period amid growing speculation that it will be acquired.  

For more:
- here's the article

Related Articles:
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Humana enters quiet period until July 29, refueling acquisition rumors