Still standing

Thursday, October 27, 2011

YARMOUTH, Maine – Several months after Apria Healthcare contracted with Humana to become a preferred provider, other HME providers have managed to maintain their footholds with the insurer.

Earlier this year, Humana announced that it had named Apria a preferred provider and said that it would terminate existing contracts with some providers. Gary Marnhout didn't lose his contract, but the provider found himself doing damage control with referral sources after a letter made the rounds giving the impression that Apria was the only game in town.

"We went to every single doctor's office, sleep lab and case manager and said, 'There have been some changes, but our company is still in-network and still taking patients,'" said Marnhout, regional vice president of Lexington, Ky.-based Bluegrass Oxygen. "We have a good name up here, people trust us and we've been taking Humana referrals ever since."

For providers who did receive termination letters from Humana, there was a small saving grace: Many of the plans had the same benefits out-of-network as in-network. That means that many providers were able to retain at least some Humana patients.

Provider Thad Connally, whose contract ended Sept. 30, said he was able to salvage about 30% of his Humana business that way—at least for now.

"We told our referral sources if they weren't sure to please call us and let us check the plan," said Connally, president of First Choice Home Medical in Bowling Green, Ky. "When Humana redoes those contracts with employers, I am sure we will be on the outside looking in."

One bit of irony for providers: Apria can't cover all of Humana's patients.

"Apria called and asked if we could take some patients for them in an area where they didn't have an office," said Marnhout. "We said no."

In fact, Humana in September added Rotech Healthcare back into its network as a preferred provider, said Teresa Camfield, executive director of the Kentucky Medical Equipment Suppliers Association.

That's just the kind of news that gives provider Wayne Sale hope. The president of Health First in Richmond, Va., didn't have a contract, but has lost Humana as a source of “open referrals.”

"Our industry prides itself on service and availability," he said. "I don't think any one company can serve the needs of an entire insurance population on its own."