Humana drops its health care plan for seniors

More than 10,000 senior citizens in Clark and Nye counties who have Humana Inc. as a health care provider will have to find a new insurance company by the end of the year, the company announced Wednesday.

The company cited a substandard reimbursement policy from the federal government -- a "fairness gap" -- as the reason behind its decision. Humana's senior Gold Plus Medicare HMO program will remain in effect only until Dec. 31.

As of Jan. 1, senior members will have the choice to return to traditional Medicare fee-for-service, purchase a Medigap supplemental insurance policy on their own or select another Medicare HMO company.

In Clark County there are only two other health maintenance organizations that have senior citizen Medicare HMO programs -- PacifiCare of Nevada and Sierra Health Services Inc.

PacifiCare is pulling out of 12 counties in Ohio, Washington, Oregon and California effective Jan. 1, but its Nevada coverage will remain unchanged, PacifiCare spokeswoman Kayla Callas said.

PacifiCare of Nevada has 22,500 senior members in Clark County.

"We are not leaving the market. We are committed to providing quality health care to the Southern Nevada community," she said.

"We stand ready to accept the Humana Medicare beneficiaries and will gladly enroll them in our Nevada Medicare product, Secure Horizons."

Sierra Health Services officials said it too is planning to continue providing Medicare HMO programs in Clark County.

Sierra Health Services senior Medicare HMO, Senior Dimensions, was the first program in the community and the company is "committed to our senior product," spokeswoman Jenny DesVaux Oakes said.

The company, DesVaux Oakes said, has 33,000 senior members in Southern Nevada and is willing to accept Humana members.

Humana's decision will affect 9,416 members in Clark County and 715 in Nye County. In all, the company is dropping Gold Plus programs in 31 of 89 counties nationwide. About 46,000 of Humana's 480,000 members, or 9.6 percent, will be affected.

"When government reimbursement of care for seniors in Medicare+Choice (Gold Plus Medicare) plans is no longer adequate to cover the cost of quality care, we have no choice but to discontinue the product," Gregory Wolf, president and chief executive officer of Humana, said in a written statement.

"Unfortunately, reimbursement changes brought on by the Balanced Budget Act have made it impossible in some markets for Humana to continue to offer some of our Medicare beneficiaries a high level of care, low cost and broad choice of providers and products."

Guy Perkins, supervisor of the Life and Health Division of the state Insurance Commission, said he just heard about Humana's decision on Wednesday.

"We are disappointed in Humana's decision," Perkins said. As of late Wednesday afternoon, he said the insurance commissioner was still waiting to receive an official reason for Humana's withdrawal from Nevada.

Sen. Harry Reid, D-Nev., said Humana's argument for pulling out of Nevada is not valid. He said the General Accounting Office did a study that showed the reimbursement was sufficient.

"Maybe they are not making enough profit," Reid said. "They should be concerned about patients and not profits."

Reid said senior citizens under the federal Medicare program need to be protected as working Nevadans are by the state's Patient's Bill of Rights -- Assembly Bill 156.

Currently a patient's bill of rights is before Congress and Reid said he plans to support it. He added that President Clinton's proposal Tuesday to have prescription drugs covered under Medicare is important.

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