Humana Contract Negotiations and Medicare Advantage Update

January 10, 2018  

To: Medicare Advantage Patients  

From: Carla A. Neiman, Chief Financial Officer  

Re: Update on Humana Contract for Clark Fork Valley Hospital  

We know that there is a continuing high level of interest in the community concerning Humana Medicare Advantage after Blue Cross Blue Shield of Montana’s withdrawal from the local market for their Medicare product. I am writing to provide our patients with the latest information I have regarding this situation. I am sorry to report that CFVH has not yet been successful in negotiating a contract with Humana.  

At this time, we are continuing negotiations with Humana for a Medicare Advantage contract that would allow our hospital and clinics to be considered participating providers for their Medicare product. We have been engaged in this process with Humana since learning that they were marketing their plan in Sanders County last October. We do not have an indication at this point whether we will be successful in reaching an agreement that will allow us to participate with Humana during 2018.  

We intend to have a final decision and we will announce to the community no later than January 31, 2018 definitively, whether or not CFVH will have a contract with Humana for the coming year. We are aware that those individuals who were previously covered by BCBS Medicare have until February 28 to make a final decision on Medicare coverage for 2018 and we want to ensure that you have adequate time to make a decision with clear knowledge of our status as a provider with Humana.  

In the meantime, if you have enrolled in the Humana HMO Plan (Humana Gold Choice HMO) effective January 1, 2018, you should be aware that if you seek services at Clark Fork Valley Hospital or one of our clinics, you are currently out of network and, as a result, you have no Medicare coverage for non-emergent services. Again, the only exception is emergency services, as defined by Humana.  

My previous letter outlined the options for our Medicare patients who were previously insured by BCBS. You can choose Traditional Medicare and a supplement to cover the coinsurance and deductibles that Medicare does not pay. Remember, the Humana Medicare Supplements are 100% fine. If you cannot afford a supplement, you are likely eligible for Clark Fork Valley Hospital’s Financial Assistance Program which offers forgiveness of up to 100% of the balance after Medicare depending on your income. There are also state programs which will assist with supplemental coverage and pharmacy coverage for low income seniors. If you need help evaluating your options, please contact the Area VI Agency on Aging (see contact info on the reverse). They have unbiased SHIP counselors who are very knowledgeable and can help.  

Clark Fork Valley Hospital will be participating in meetings with the Area VI Agency on Aging at the local Senior Centers in January. Our staff will be available to answer questions and provide information about our Financial Assistance Program. Please see additional information with the tentative schedule on the reverse side.  

Finally, we know that you have a choice of health care providers, and we value our relationship with you. As we have seen, insurance providers will come and go, but Clark Fork Valley Hospital is committed to caring for the residents of Sanders County and we will always be here to serve our community. We sincerely regret this situation which has developed beyond our control and we will continue to do our best to address it.            

Medicare Coverage Assistance:  

You can find more information at The Montana State Health Insurance Assistance Program (SHIP) is a free health-benefits counseling and advocacy service for Medicare beneficiaries and their families or caregivers. Their mission is to educate, advocate FOR, counsel and empower people to make informed benefit decisions. 

The Montana SHIP is an independent, objective, and confidential assistance program funded by The Administration on Community Living and is not affiliated with the insurance industry. This program is based and operated through the Area Agencies on Aging; you may contact your local SHIP Counselor at 1-800-551-3191 or contact the Western Montana Area VI Agency on Aging directly at 1-800-266-4188 or your local office at 406-883-7284.  

Clark Fork Valley Hospital Medicare Financial Assistance Program:  

Apply with a simple application. You need only apply once per year. Eligibility is based on income level and household size. Savings and assets are not included. Once approved, the applicable discount is applied to the balance after traditional Medicare and any available supplemental insurance have processed the claim for each encounter at CFVH and clinics. For more information contact Darlene Malmend at 406-826-4962 or Debbie Buckingham at 406-826-4859.  


Tentative Schedule for Senior Center Meetings with Agency on Aging – January, 2018:     

Wednesday, January 17, Hot Springs Senior Center 12:00 noon      

Thursday, January 18, Thompson Falls Senior Center 6:00 p.m.      

Monday, January 22, Noxon Senior Center, 5:15 p.m.

Wednesday, January 24, Plains Senior Center 11:45 a.m.

Wednesday, January 24, Heron Senior Center 5:30 p.m.

Thursday, January 25, Tribal Nutrition Center, 11:30 a.m.