CHARLESTON, W.Va. - Call it the power of word processing: two letters set off a chain of events last month that still has thousands of state Medicare recipients shaken up, hospital administrators scratching their heads and West Virginia lawmakers fighting mad.
On Dec. 5, Thomas Health System president and CEO Steve Dexter received a letter from the Medicare Advantage provider Humana.
The one-page letter said Humana would terminate its contract with St. Francis Hospital effective Feb. 1, 2012.
"The dynamics in the Charleston area have changed and the ChoiceCare Network is reconfiguring its network," read the opening sentence.
One day later, an identical letter arrived at Thomas Memorial Hospital in South Charleston. The letters, signed by director of contracting Beverly Steen, quoted part of Humana's agreement with the hospitals:
"Either party may terminate this agreement without cause at any time . . . by providing to the other party 90 days prior written notice of termination."
Dexter said the correspondence came "totally out of the blue." It was such a surprise that the CEO didn't think the letters were genuine.
He called Humana, and representatives told him not to worry. They said the company was canceling all of its contracts and drafting new ones.
Dexter received that new contract a week later and found it did not include any personal coverage for Humana Medicare patients.
Again, the CEO was blindsided.
Between 2009 and 2011, about 3,600 of the hospitals' patients received health coverage through Humana.
Thomas Health Systems' contract with the company was set to expire Jan 31, 2012. Hospital officials figured if Humana were to terminate its contract, they would have received word in late October or early November.
"We wrote back and said, 'Do the math,' " Dexter said. "You gave us 56 days notice."
Humana customers received a letter from the company around Christmas Eve announcing St. Francis and Thomas would no longer be in Humana's coverage network.
The letter included a list of in-network hospitals, like Charleston Area Medical Center's four hospitals, Boone Memorial in Madison and Montgomery General in Fayette County.
"This change doesn't affect your benefits," the letter continued. "Your Humana plan benefits remain the same. When you need to go to a hospital, your primary care physician can help you choose the hospital that is right for you."
That apparently did not do much to comfort Humana customers.
Medicare Advantage plans are sponsored by the federal government but sold and administered by a handful of private companies.
Eligible persons can enter Medicare at any time, but there's a limited window to enter a Medicare Advantage plan. That "open enrollment period" stretched from Oct. 15 to Dec. 7 this year.
After Dec. 7, patients could not switch from one Medicare Advantage plan to another until the next year's open enrollment period. With the contract terminated, Thomas and St. Francis patients in a Humana plan would have to seek treatment elsewhere, at least until October.
Patients can switch back to a regular Medicare plan at any time, but Dexter said that's not an option for many people. Regular Medicare premiums and co-payments are higher, and regular Medicare doesn't offer dental or eye-care coverage as some Medicare Advantage plans.
St. Francis and Thomas soon were swamped with calls. Dexter said the hospital system received so many calls from concerned patients that it had to pull its public relations director and two secretaries away from their regular duties to man the phone lines.
Patients also started calling West Virginia's congressional delegation, as well as the attorney general, state insurance commissioner and governor's offices.
The state's political leaders quickly responded.
U.S. Rep. Shelley Moore Capito, R-W.Va., called Dexter on his cell phone to ask what she could do to help. Sen. Jay Rockefeller, D-W.Va., sent a letter to Humana on Jan. 4, about a week after patients received their letters from Humana.
"I am outraged," Rockefeller wrote.
"My office has received hundreds of calls from panicked seniors who are afraid they will lose access not only to their preferred hospital, but also to the affiliated physicians they know and trust. I have even received reports that some of these patients have cancelled surgeries in reaction to the news."
Rockefeller condemned the Medicare provider for their poor customer service.