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Negotiations between Humana, hospitals, break down

CHARLESTON, W.Va. -- Charleston Area Medical Center officials say Humana's claims the hospital system is trying to limit patients' healthcare choices are "unfounded."

In a statement emailed late Thursday, spokesman Dale Witte said CAMC hospitals "will still be accessible to Humana's beneficiaries, but will be considered out of network by Humana."

"In addition, CAMC has contracts with many other insurance companies, and patients can choose to enroll in these as well," Witte said in the release.

"As always CAMC is committed to caring for its community and will do everything it can to assist any patients through this transition. It is disappointing that Humana officials out of Louisville, Ky. have decided to attempt to negotiate a contract through media outlets."

According to a Wednesday release from Humana, Charleston Area Medical Center told the insurance company to drop Thomas Memorial and St. Francis hospitals from its network or risk losing CAMC's business.

That led to a breakdown in contract negotiations earlier this week, Humana representatives said.

"CAMC made it clear their goal in negotiations with Medicare Advantage payers is to direct and steer volume to their facilities. This is best achieved when they are the only participating hospital system in the network," Humana representatives said in an unsigned statement emailed late Wednesday.

"It's Humana's strong preference to have both hospital systems in Charleston in our health care provider network -- to preserve choice for our members in the area," the statement said. "It became clear in our conversations that Humana could not achieve its goal of preserving contractual relationships with both hospital systems in the Charleston area." 

CAMC executives would not comment on why the negotiations fell through at a Wednesday board meeting.

"I don't really want to go into any specifics," CEO Dave Ramsey said, adding that he did not want any "ill will" between the hospital system and Humana that would harm future negotiations.

Steve Dexter, Thomas Health System's president and CEO, also released a statement about the Humana and CAMC's failed negotiations on Thursday.

"This is unfortunate for our community. Patients must have access to healthcare, and they should be able to choose their doctors and hospitals based on quality and service," Dexter wrote.

"Both Thomas Memorial and Saint Francis strive for the highest quality of care. We are patient advocates and very interested in contracting with all Medicare Advantage Plans in our area."

Thomas Health System had its own contract scuffle with Humana late last year.

Around Christmas, Humana customers received letters from the company saying medical services at Thomas and St. Francis would no longer be covered at in-network rates. Those letters prompted hundreds of calls from patients to Humana, the hospitals, state officials and federal lawmakers.

U.S. Sens. Jay Rockefeller and Joe Manchin sent letters to Humana, condemning the company for canceling its contract.

Humana announced on Jan. 5 its customers at Thomas and St. Francis would continue to be covered at in-network rates for the rest of 2012, though the hospitals remained outside its coverage network. Then, on Jan. 18, the insurance company announced the hospitals were back under contract.

At the time, Humana spokesman Jeff Blunt said he could not discuss the history of Humana's discussions with St. Francis and Thomas Memorial and "can't share the rationale" behind the company's earlier decision to terminate its contract with the hospitals.

When asked this week if CAMC influenced the company's decision to drop St. Francis and Thomas, Blunt declined comment.

"I can also tell you that we feel it would be inappropriate discuss the situation a year ago with St. Francis and Thomas.  We were pleased that it worked out that we could keep both systems in network for our members in 2012 and we're working toward a resolution with CAMC that will allow us to do the same in 2013," he said in an email.

Thomas spokeswoman Paige Johnson also would not comment on last year's contract negotiations, or CAMC's involvement in them. 

Contact writer Zack Harold at 304-348-7939 or zack.harold@dailymail.com. Follow him at www.twitter.com/ZackHarold.


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