Humana misrepresented the providers its Medicare Advantage plans will be in-network with in 2025, Minnesota Attorney General Keith Ellison alleged.
Mr. Ellison sent a letter to Humana CEO Jim Rechtin Nov. 22, expressing concern the insurer listed Duluth, Minn.-based Essentia Health and other systems as in-network for its 2025 Medicare Advantage plans on its website. Essentia Health has said it will be out-of-network with Humana MA plans in 2025.
In a Nov. 26 news release, Mr. Ellison alleged Humana also listed Sioux Falls, S.D.-based Avera Health, Robbinsdale, Minn.-based North Memorial Health and Sioux Falls, S.D.-based Sanford Health as in-network for 2025.
All three systems have said they intend to exit Humana's Medicare Advantage network at the end of 2025.
The Minnesota Star-Tribune reported Humana and UnitedHealthcare listed systems that had no contract agreement for 2025 as in-network on their websites. Humana told the outlet on Nov. 1 that it was updating its online provider directory with in-network providers for 2025.
In his letter to Mr. Rechtin, Mr. Ellison asked Humana to provide the state with an "explanation as to whether and to what extent" the company listed out-of-network providers as in-network during the open enrollment period.
The attorney general also asked the company to describe the steps it will take to correct any possible incorrect information, including any plans to reimburse consumers for out-of-network care if they signed up for a Humana plan believing their provider was in-network.
"If Humana did indeed share this misinformation, I urge Humana to make all possible haste and take all efforts possible to correct it," Mr. Ellison said in a Nov. 26 statement. "It is essential that Minnesotans considering a Medicare Advantage plan have accurate information about what that plan will and will not cover."
Becker's has reported on at least two dozen hospitals and health systems dropping some or all Medicare Advantage contracts. Among the most common reasons providers cite for leaving MA are excessive prior authorization denial rates and administrative challenges.
Some health systems have reached new contract agreements with Medicare Advantage plans after informing patients they intend to leave their networks. In September, Essentia Health said it would no longer accept UnitedHealthcare Medicare Advantage plans. In November, the health system and insurer reached a new agreement to remain in-network for 2025.
Becker's has reached out to Humana for comment and will update this article if more information becomes available.