SOUTH DAKOTA(DRGNews)- One medical system based in South Dakota is severing its ties as an in-network provider for Humana Medicare Advantage at the end of this year.
In a news release, Avera Health says there are ongoing issues with Humana that negatively affect the patient experience. Among those are delays in care due to long waits for prior authorizations and denials of necessary services and care.
Avera Health has mailed a letter to patients who carry Humana Medicare Advantage coverage about this change and has informed them about how to consider other plan options. Patients can select a new plan during the fall Medicare open enrollment period of Oct. 15–Dec. 7, 2024. Avera will also assist patients who stay with Humana and need to transfer to one of that company’s in-network providers.
Stacey Lenker, Vice President of Payer Strategies for Avera Health, says they understand this will mean a change for numerous patients. She says they made repeated attempts to resolve the concerns with Humana, but continue to encounter the issues.
Lenker says 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
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