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Vanderbilt vs Humana: Who Will Back Down First?

Have you heard about the contract dispute between Vanderbilt University Medical Center and Humana?

Vanderbilt University Medical Center (VUMC) has threatened to drop Humana as a Medicare Advantage insurance provider unless Humana increases payments for services. This dispute is getting plenty of attention, so much so that Nashville Mayor John Cooper has entered the conversation. He is urging both sides to continue negotiations so that Metro employees aren't affected. If a deal isn't reached, VUMC will drop Humana as a Medicare Advantage provider on April 1, 2023.

Why is this happening? Quite simply, it’s a contract game. There can be disputes for any number of reasons. These are big deals. A lot of money is involved, and each side is going to blame the other.

We've seen this kind of posturing before. When I worked with the State Health Insurance Program (SHIP) a few years ago, there was a similar stand-off between Vanderbilt and Blue Cross Blue Shield. Everyone was certain that the two companies would settle their differences. They didn’t. Vanderbilt dropped Blue Cross Blue Shield. The two companies didn’t have a working relationship for about six years. This was a major deal at the time because Blue Cross Blue Shield was one of the biggest Medicare Advantage plans in Tennessee.

This dispute between VUMC and Humana could end up the same way. My understanding is that the two companies are still in talks. They could mend it. Or not.

I’ve been getting a lot of questions about what it might mean for people on Medicare if VUMC and Humana can’t work things out. If you’re on Original Medicare, this move won’t impact you at all. However, if you’re on Humana’s Medicare Advantage Plan, you could be affected.

If there is any good news about this dispute, it is that it is happening during the Medicare Advantage Open Enrollment Period that runs until March 31. During this open enrollment period, people on Medicare Advantage plans can swap to other Advantage plans.

If the two entities can’t patch things up, you will have some decisions to make in March if you’re in Humana’s Medicare Advantage Plan. If you want to keep your Vanderbilt providers, you will need to choose another Medicare Advantage plan. If you want to stick with Humana, you will have to choose providers not affiliated with VUMC. It really depends on how tied into Vanderbilt are you. If everybody you see is at VUMC, you probably need to swap your coverage. If you work with just one doctor affiliated with VUMC, it might be easier to keep your Humana plan and find a new doctor.

For Metro retirees, the decision will be a bit more challenging. If VUMC and Humana can’t resolve their differences, all Metro retirees will be affected because they are enrolled in Humana’s Medicare Advantage Plan. If you give up your retiree coverage, it's gone. You can't just jump back into it later.

If you are a member of Humana’s Medicare Advantage Plan and you go to doctors at VUMC, here’s what to do right now.

  1. Hope for the best. Humana and VUMC have until March 31 to reach an agreement.

  2. Plan for the worst. If you have Humana coverage, you want to keep your VUMC doctors, and the two sides can’t resolve their differences, you will need to switch plans. That said, I wouldn't immediately go out and swap because you might lose a doctor that you want to keep. Medicare Advantage open enrollment continues through the end of March, so you have plenty of time to research your options. This is one of those rare instances where waiting works to your advantage. Just get your stuff together and be ready to do a review if needed.

  3. Get your popcorn. Watch and wait as the standoff plays out. Let’s see who folds first.

In the meantime, if you have any questions about your Medicare coverage, just give our office a call at 615.824.2571.



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