Community Care Physicians, Albany Med hospitals to drop Humana Medicare Advantage plans

Feb. 20—Community Care Physicians and hospitals in the Albany Med Health System have announced plans to drop Humana Medicare Advantage plan coverage, leaving an untold number of patients with three options: pay for care out of pocket, switch insurers or find new doctors.

News of the change first came to light last November, when Community Care Physicians (CCP) sent a letter to patients indicating plans to drop Humana Medicare after March 13 due to "increasingly cumbersome" requirements imposed by the insurance provider. The letter also encouraged patients to take advantage of the Medicare open enrollment period — when Medicare recipients can make changes to their health care benefits for the upcoming year — to find a new insurer accepted by the medical group.

"Unfortunately, the requirements imposed by Humana have become increasingly cumbersome," the Nov. 21, 2023 letter reads. "We need insurance partners who understand our patient and provider needs, allow for independent provider decision-making, and don't have burdensome processes that delay care."

CCP employs more than 420 practitioners across 70 practices spread throughout the Capital Region and portions of the Mohawk Valley, including Saratoga, Schenectady and Montgomery counties.

The medical group confirmed in a pair of letters sent to patients earlier this month that Humana Medicare Advantage patients will have to begin paying out of pocket effective March 13 to see their doctors and that "this decision is final."

"If you have this insurance, we are not discharging you from our practice and will continue to see you, but you should select another insurance to avoid paying out of pocket for your care. We accept many insurance plans from which you can choose that offer comparable coverage," CCP wrote in a Feb. 13 letter.

But CCP is not the only major medical provider that has announced plans to drop Humana Medicare this year.

Albany Med Health System has also announced it will no longer be included in Humana's Medicare network beginning July 1. The change applies to all hospitals belonging to the sprawling health care system, including Albany Medical Center, Saratoga Hospital, Glens Falls Hospital and Columbia Memorial Health in Hudson.

Matthew Markham, a spokesperson for the hospital system, said the change does not impact Humana's commercial, military and Medicare Supplement Insurance programs.

A Medicare Advantage plan is provided through a private insurer. A Medicare supplement can be purchased to fill gaps in insurance not covered under regular Medicare plans.

News of the changes have sent Humana Medicare recipients like Margaret Brennan scrambling and worried about having to find new doctors.

Brennan, a 79-year-old Niskayuna resident, receives her insurance as part of her retirement package from Rensselaer County. She switched all her doctors to CCP in order to simplify her care.

"It's causing me a great deal of stress," she said.

Brennan said she has been seeking clarity on what necessitated the changes but has yet to receive clear reasoning, despite multiple letters from CCP notifying patients of the change.

She recently began a social media campaign in hopes of bringing greater clarity to others about the situation.

"It's very confusing and it's very stressful," Brennan said.

Alexis Musto, a CCP spokesperson, acknowledged there has been "misinformation" circulating, but clarified that the change was necessitated by administrative burdens imposed by Humana.

"Unfortunately, Humana has an overly burdensome process, particularly administrative burdens," Musto said in an email. "This includes burdensome claims processing and excessive denials; prior authorizations for medications, procedures, etc; claims resulting in patient responsibility when Humana should have paid the claim. This puts patients in the middle, delays patient care, and doesn't allow independent clinical decision making in our system."

Musto also clarified that Humana Medicare Advantage recipients will also be required to pay out of pocket following a visit to CCP, but noted that the medical group will continue to file a claim with Humana as a "courtesy" to patients. The decision to reimburse patients will be left to the discretion of Humana.

It's unclear how many patients are expected to be impacted by the change. Musto said CCP does not disclose insurance information about patients and referred additional comment to Humana.

Humana, in a statement, did not provide information on how many individuals would be impacted by the change, but noted that the changes will have no impact on Humana's Medicare Supplement Insurance plan policyholders, and that the company is open to holding "future discussions."

"Both Albany Med Health System and Community Care Physicians have informed Humana that they are terminating our Medicare Advantage agreements," Humana said in a statement. "We are open to future discussions regarding network participation. Humana maintains a large network of highly-rated hospitals and providers, and we will work with our Medicare Advantage members to help them select new in-network providers to ensure their care is not interrupted."

Markham also did not answer questions about how many Albany Med System patients would be impacted by the upcoming change, but in a statement, also indicated the decision to drop Humana Medicare insurance was brought on over administrative conflicts.

"Patient care is the most important aspect of our mission, and we look for insurance partners who share our values of putting patient needs first. One of our central beliefs is to be an advocate for patients," Markham said. "When working with insurance providers, we strive to ensure the terms are fair to us and fair to our patients."

Emergency room visits will remain open to all patients regardless of insurance, said Markham, who noted the hospital has sent letters to patients informing them of the upcoming change and information on other participating insurance plans.

Other regional hospitals, including Ellis Hospital in Schenectady, Nathan Littauer Hospital in Gloversville and St. Mary's Healthcare in Amsterdam, will continue to accept Humana Medicare Advantage insurance. St. Peter's Health Partners will also continue to accept the insurance.

"St. Mary's Healthcare is in network with Humana Medicare; continue to work with all of our payers; and have no plans to change our relationship with Humana," Kristin Mosher, a spokesperson for the hospital, said in a statement. "We are happy to provide care to those patients who have coverage through Humana and now find themselves out-of-network with their current provider."

But changing medical providers is no easy task for patients like Brennan, who said she will be 80 by the time the changes take effect and is worried about finding the same quality of care at an affordable rate.

"I'll have to go find an urgent care that will accept my insurance," she said.

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