Jan 12, 2023 - News

Nashville mayor weighs in on insurance dispute

Photo illustration of Nashville Mayor John Cooper with lines radiating from him.

Photo illustration: Allie Carl/Axios; Photo: Leah Puttkammer/Getty Images

Mayor John Cooper has stepped in to urge Vanderbilt University Medical Center and Humana to resolve a dispute over insurance coverage.

  • VUMC has begun informing patients it will stop accepting Humana's Medicare Advantage plan on April 1 because of a disagreement over reimbursement rates for medical care.
  • The health system also plans to stop coverage of the Wellcare Medicare Advantage plan.

Why it matters: Metro government pensioners and retirees over 65 use Humana’s Medicare Advantage plan. The mayor wrote a letter to executives at VUMC and Humana, saying the change "could pose sudden, drastic, and potentially harmful consequences."

  • The change would also upend coverage for other residents on that plan.

Driving the news: In his letter, Cooper asked VUMC and Humana to continue "expedited negotiations" in an effort "to prevent what could otherwise unfold into catastrophic scenarios."

  • If negotiations fail, Cooper requested VUMC and Humana agree to make accommodations for patients who get the plan through Metro.

What they're saying: "The change is necessary because health systems like VUMC need to be paid fairly for services they provide and continue to contend with higher costs for personnel, supplies, equipment, and medications necessary to provide high quality care," VUMC said in a statement.

  • VUMC spokesperson Craig Boerner tells Axios, "We continue to be willing to negotiate reasonable rates with Humana."

The other side: Humana tells Axios in a statement that VUMC wanted reimbursements for all care to increase by 20% and that "they are unwilling to discuss a new rate that is anything less."

  • "Humana would like to retain VUMC as an in-network provider, and we hope to reach a new agreement with VUMC prior to April 1, 2023. But asking Humana and our Medicare Advantage members to start paying 20% more for all VUMC services is not acceptable."

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