Something insidiously unsettling is happening to health care, and I'm not even getting into a political commentary about the pros or cons of the ACA, aka Obamacare. Insurers are dropping providers from their networks without any apparent cause. Patient care may be drastically affected. For perspective, the only medical oncologists in the entire Southwest Florida region are Florida Cancer Specialists. Eliminating the entire group from a network forces patients in those plans to have to drive hundreds of miles, possibly, to find a similar physician.
Read the following article from Naples News:
Humana dropping Florida Cancer Specialists as covered practice
By LIZ FREEMAN
Saturday, November 2, 2013
NAPLES — Brenda Wallace finished chemotherapy for breast cancer at Florida Cancer Specialists a year ago this month.
The Naples grandmother counts herself lucky — for the successful outcome and because the large group practice operates in Southwest Florida.
“I still go for testing every couple of months,” the 68-year-old said.
But her insurer, Humana, is dropping the cancer group from its network of providers effective March 15, 2014, said Dr. William Harwin, who founded the group in 1984.
The Louisville-based Humana sent the practice a cancellation notice in September. It applies to all Humana plans, the Louisville-based insurer confirmed.
“No reason was given,” Harwin said. “It was without cause.”
Patients are getting notices from Humana and are upset, he said, adding that the insurer will allow current patients to continue getting treatment with his group, even after the termination takes effect.
“They have to allow us (to continue) until the treatment is over,” he said. “Our first priority is to take care of our patients.”
In Collier, the cancer group is the only outpatient provider of chemotherapy services, said Sarah Cevallos, vice president of payer contracting for the cancer group.
The termination letter said it’s due to a change in Humana’s business model and conflicting views of Humana policies and procedures.
“I have no idea what that means,” Harwin said. “We have made many efforts to try and resolve the situation.”
The cancer group has 162 physicians and extensive support staff in 80 practice locations in Florida serving 12,000 Humana-insured patients, Harwin said.
Nancy Hanewinckel, Humana’s regional spokeswoman, confirmed the cancer group is being terminated.
No other provider groups in Southwest Florida are being terminated, she said.
“Humana must sometimes make difficult business decisions regarding providers in our participating networks and, when this happens, our goal is to reduce disruption to our members as possible,” she said in an email. “Members in current treatment will continue care with their current (cancer group) provider.”
Hanewinckel said Humana nurses are reaching out to members undergoing treatment to answer any questions about continuing care.
Humana intends to have several established oncology groups in its network in Collier by next March when its relationship ends with the cancer group, she said.
Cevallos, with the cancer group, said there’s been no indication yet that Humana is aligning with another group to provide chemotherapy services.
Officials at 21st Century Oncology, which provides radiation services in Lee and Collier, couldn’t be reached for comment.
Harwin said he has a meeting scheduled for Nov. 11 with Humana officials to try to get the decision reversed. In addition, he has filed an appeal, which gets reviewed by a physician review panel.
Harwin doesn’t believe Humana’s decision is based on any medical malpractice claim or that it’s being done to get an upper hand on contract negotiations.
Wallace, the breast cancer survivor treated last year in Naples by the cancer group, hopes there’s a change of heart by Humana. She has Humana’s Medicare Advantage plan now but is switching to traditional Medicare starting in the new year.
“You do develop a relationship with your doctor who has your life in his hands,” she said.
© 2013 Scripps Newspaper Group — Online