Parts of Palm Beach county are falling into a health insurance black hole.
Most Humana policy holders, who normally rely on the two hospitals in Boca Raton, may now have to pay out of network prices.
Health insurance companies and hospitals negotiate agreements one how to settle medical payments. In statements, Humana and the owners of six hospitals in Palm Beach County blame each other for a breakdown in reaching new agreements.
Charles Lerman is one of the thousands of policy holders caught in the middle.
“She's 4-weeks-old this Monday,” Lerman said pointing to a picture of his newborn daughter.
He said Julia was born with a stiff neck muscle. So he has to take her to a physical therapist about once a week.
“It kind of limits her range of motion to one side,” he explained.
Lerman wants to take Julia to West Boca Medical Center. It has a pediatric-specific program and is close to his home.
The problem is the owner of West Boca Medical Center, Tenet, stopped accepting Humana insurance in October.
That means Lerman and others have to pay out of network, more expensive, copays.
“It’s the most frustrating thing in the world,” Lerman said of having insurance he can’t use where he’d like to.
Adding to the frustration is Lerman's alternate hospital in town, Boca Raton Regional Hospital, may stop accepting some Humana policies Jan. 1.
“There is nobody within a 30-minute drive,” Lerman said of his search for a pediatric physical therapist in his network.
So Lerman has to choose whether to drive out of the way or pay more.
There is some good news. A Boca Raton Regional spokesman said the hospital is close to a deal with Humana to extend in-network coverage for all Humana policies next year.
But Tenet, the owner of five Palm Beach County hospitals said it is far apart on terms to a new contract with Humana.
“Despite our repeated attempts to find common ground, Humana made it clear they would rather compromise their members’ access to certain doctors and hospitals rather than work together to complete a contract. We remain far apart on key aspects of a new contract, and as a result, we anticipate that we will remain out of Humana’s network during the coming year, and for the foreseeable future.”
Humana responded with a statement which said in part, “Humana is still in negotiation with Tenet on a new contract, but so far Tenet has not agreed to terms that are fair and reasonable for our health plan members and customers.”
Lerman feels like he’s caught in the middle.
“I’m sure it takes two to tango,” said Lerman. “I’m sure the insurers want to pay as little as possible and the hospitals want to get as much as possible.”
Tenet encouraged Humana members to visit www.ProtectMyAccess.com, or call its community information line at (800) 290-0836 for help finding a provider.
