Avera Health, which includes Marshall County Healthcare Center in Britton, will end participation as an in-network provider with Humana Medicare Advantage on Dec. 31, 2024, due to ongoing issues that negatively affect the patient experience.
Among issues that are creating difficulties for patients are delays in care due to long waits for prior authorizations and denials of necessary services and care.
“Locally we have had numerous issues that have not been resolved with Humana Medicare Advantage plans,” said MCHC CEO Nick Fosness. “Ending the relation with Humana is unfortunate, but necessary.”
Avera Health has notified patients who carry Humana Medicare Advantage coverage about this change through a mailed letter and has informed them about how to consider other plan options. Patients can select a new plan during fall Medicare open enrollment period of Oct. 15 – Dec. 7, 2024. Avera will assist those patients who stay with Humana and need to transfer to another provider.
“At Avera, we want our patients to have an excellent experience. We understand this will mean a change for numerous patients. This was a difficult decision, but we feel it is in the best interest of our patients and providers,” said Stacey Lenker, Vice President of Payer Strategies, Avera Health. “We have made repeated attempts to resolve concerns with Humana, but continue to see these issues.”
Patients who choose to keep their Humana Medicare Advantage plan for 2025 can still receive care from Avera providers, however, services would likely be out of network, and that may mean a higher cost share for patients.
Avera Health will be in the Humana Medicare Advantage plan network through Dec. 31, 2024. Patients who have appointments or procedures scheduled in 2025 should check their 2025 Medicare plan coverage network to make sure their Avera provider, surgery center or hospital is included, and contact their insurance company if they have questions about coverage.
“Medicare open enrollment from Oct. 15 to Dec. 7 is the best opportunity for Medicare enrollees to consider their coverage for 2025. They have opportunity to change between Medicare Advantage plans, or to select Original Medicare plus a Medicare Supplement plan,” Lenker said.
Fosness added, “If patients have questions, as always-please give us a call and ask to speak with financial services and we can sure address any concerns.”
