Miami University's department of human resources provided information to employees Dec. 19 in an e-mail regarding Humana's negotiations with Premier Health Partners. Please see letter to employees below.
As you know, the university's healthcare plan administrator will change from Anthem to Humana beginning Jan. 1, 2009. The selection of Humana as the university's new administrator was the result of a careful and thorough review process. The availability of and access to networks of hospitals and doctors was one of many items given careful consideration.
Miami relies on its healthcare plan administrator to maintain networks of providers and negotiate provider reimbursement rates. Over the past several months Humana has negotiated with Premier Health Partners, operating mostly in the Dayton and Middletown areas, on behalf of all of its clients with the goal of maintaining Premier as an in-network provider. As you may have recently read in the news, it does not appear that negotiations will be successfully completed before Jan. 1, 2009. While discussions may continue and these types of negotiations are often settled at the last minute there is a wide gap in expectations between the parties that may make this less likely to occur.
As noted below, employees can access Humana's provider directory to review the numerous alternative providers available to them located in and around the area served by Premier Health Partners. Most notable is the potential loss of service at Miami Valley and Good Samaritan hospitals and Upper Valley and Atrium medical centers.
While we're disappointed that the list of in-network providers will be impacted if resolution is not found between Humana and Premier, we remind you that it is important to utilize in-network facilities and providers; this results in a dramatic cost savings for employees. Employees may review Humana's network to confirm participation of their current providers and review alternative providers by visiting www.muohio.edu/benefits and clicking the "Find a Provider" link or by contacting Humana at 1-888-393-6765 prior to Jan. 1.
Additionally, it is important to note that emergency services are treated as in-network regardless of where the services are received.
For employees and/or members that will be impacted if Premier and Humana don't reach an agreement there is a transition of care period. This allows individuals to continue to receive care with their current providers at an in-network status for a period of 90 days allowing for a smoother transition to a new provider. To participate in this transition period employees/members must complete and submit a Transition of Care Form to Humana. (See below) The form can also be obtained by contacting Humana's customer service number listed on the back of the ID card.
Humana is also working to bring new providers into its network for the benefit of all groups. They have been engaged in positive negotiations and discussions with Reid Memorial Hospital, located in the Richmond, Indiana area, over the past several months and believe they will reach a successful conclusion in the first quarter of 2009.