Where do Humana's new prices leave Apria

Wednesday, July 24, 2013

LAKE FOREST, Calif. – Apria Healthcare may have a lot to lose from Humana’s decision to use pricing from Round 2 of competitive bidding for its Medicare Advantage plans starting July 1.

Back in 2011, the insurance giant sent shock waves through the industry when it named Apria its “provider of choice” in multiple states and terminated relationships with “several providers.”

When contacted by HME News, Lisa Getson, executive vice president of government relations and corporate compliance for Apria provided the following statement:

“All I can say is that, at every turn, in every customer meeting, we emphasize that the Medicare competitive bidding program, rules, policies and rates only apply to Medicare Part B DMEPOS. It does not apply to Medicare Part C, Medicaid, commercially insured populations or any other non-Part B service.”

Getson continued: “While we expect managed care organizations to try to adopt certain aspects of the program, it’s the responsibility of every company contracted with MCOs to ensure that (the MCOs) understand the rules differ and they cannot pick and choose which Medicare policies they want to follow.”

Humana plans to cut reimbursement by, on average, 45% for applicable DME in 91 cities. It also plans to cut reimbursement by, on average, 72% for diabetes supplies as part of the national mail-order program.

Apria has confirmed to HME News that it accepted 371 contracts under Round 2, mainly in its core business lines of oxygen, CPAP and enteral nutrition, as well as a “significant number” of contracts for negative pressure wound therapy.