Tessa Quinn
Vanderbilt University Medical Center (VUMC) has terminated its participation with specific Medicare Advantage plans, including those offered through Humana, Wellcare of Tennessee, and Blue Cross Blue Shield Tennessee. This decision, effective April 1, 2023, was made due to the need for health systems like VUMC to receive fair compensation for their services. While VUMC expressed a willingness to negotiate reasonable rates, the termination has led to patients with these plans transitioning to other medical facilities and doctors. Vanderbilt Tullahoma-Harton Hospital also provides specific Medicare Advantage plans, indicating that acceptance may vary across different Vanderbilt hospitals and facilities.
| Characteristics | Values |
|---|---|
| Vanderbilt Hospital's Medicare Advantage Plans | BlueCross BlueShield BlueCard, BlueCross Medicare Advantage PPO, Cigna (aka HealthSpring) Medicare Advantage, Cariten Medicare Advantage ChoiceCare, Humana Medicare Advantage, Wellcare Medicare Advantage |
| Vanderbilt Hospital's Dropped Medicare Advantage Plans | Blue Cross Blue Shield Tennessee Medicare Advantage, Humana, UnitedHealthcare, Aetna, Cariten Medicare Advantage HMO, Humana Medicare Advantage HMO |
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What You'll Learn
- Vanderbilt University Medical Center (VUMC) terminates specific Medicare Advantage plans
- Blue Cross Blue Shield Tennessee Medicare Advantage not accepted
- Humana Medicare Advantage plans dropped
- Wellcare of Tennessee Medicare Advantage plans terminated
- Vanderbilt Tullahoma-Harton Hospital out-of-network plans
Vanderbilt University Medical Center (VUMC) terminates specific Medicare Advantage plans
Vanderbilt University Medical Center (VUMC) has terminated specific Medicare Advantage plans. The decision affected patients insured through specific plans offered by Humana and Wellcare of Tennessee. The termination came into effect on April 1, 2023.
In a statement, VUMC cited the need to be paid fairly for the services they provide as the reason for the change. The statement also mentioned the increasing costs of personnel, supplies, equipment, and medications as factors that have contributed to unprecedented cost increases. VUMC was willing to negotiate reasonable rates with Humana and Wellcare.
Wellcare expressed disappointment over the lack of an agreement and stated that VUMC's rate demand was not in the best interest of their members or the local communities they serve. They hoped to reopen discussions and reach a new contract based on reasonable rates.
It is important to note that this change does not affect all Medicare Advantage plans. VUMC continues to participate in other Medicare Advantage plans, and patients can verify their specific insurance plan's acceptance at VUMC. Additionally, there may be circumstances where members can continue care with VUMC for a specified time for continuity of care reasons.
This decision by VUMC is not an isolated case, as at least 25 providers nationwide have dropped Medicare Advantage groups in 2024, according to Becker's Hospital Review. Trade groups, such as the American Hospital Association, have highlighted concerns about insurance companies' late payments and increased denial rates for Medicare Advantage members.
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Blue Cross Blue Shield Tennessee Medicare Advantage not accepted
Vanderbilt University Medical Center no longer accepts the Blue Cross Blue Shield Tennessee Medicare Advantage plan, also known as Blue Advantage. This is according to a report by Becker's Hospital Review, which also noted that at least 25 providers across the US are dropping Medicare Advantage groups in 2024, including plans under Humana, UnitedHealthcare, and Aetna.
Blue Cross Blue Shield of Tennessee offers a range of health insurance plans, including Medicare Advantage. Their Blue Advantage (PPO)SM plan, for example, earned 4.5 out of 5 stars from the Centers for Medicare & Medicaid Services (CMS) for 2025. This plan provides members with a network of doctors, hospitals, and specialists they can choose from.
However, it is important to note that not all medical facilities and providers accept this plan. In the case of Vanderbilt Health in Nashville, TN, their website specifically excludes Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage from the insurance plans they accept. This exclusion applies to multiple facilities within Vanderbilt Health, including VUMC, MCJCHV, VWCH, VBH, and VTHH, each of which is listed with specific network exclusions.
If you are a member of the Blue Cross Blue Shield Tennessee Medicare Advantage plan, it is recommended that you directly contact the hospital or medical facility you intend to visit to confirm whether they accept your insurance plan. It may be necessary to explore alternative options within your network or consider other insurance plans accepted by the facilities you prefer.
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Humana Medicare Advantage plans dropped
Vanderbilt University Medical Center will no longer be accepting Blue Cross' Medicare Advantage plan. This is in addition to the exclusion of Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage at Monroe Carell Jr. Children's Hospital at Vanderbilt.
Humana Medicare Advantage plans have been rated below the industry average, receiving a rating of 3.63 stars out of 5 from the Centers for Medicare & Medicaid Services (CMS) for 2025. This is a drop from the previous year, where 87% of plans were rated 4 stars or higher. Only 25% of Humana's Medicare Advantage members will be in plans rated 4 stars or more for the 2025 plan year.
Humana has cut some of its Medicare Advantage benefits for 2025, particularly supplemental benefits like over-the-counter and flex cards. Humana's star rating decline is expected to affect its finances in 2026, as the CMS uses these ratings to determine whether a plan receives a bonus and its ability to bid against a higher benchmark rate.
Humana offers Medicare Advantage prescription drug plans, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage. The company's Medicare Advantage plans are available in most counties, and many of them offer a Part B Giveback benefit.
Humana PPO plans allow members to visit any Medicare-approved doctor who accepts Humana's plan terms. Medicare Advantage plans set a limit on out-of-pocket expenses, after which members pay $0 for covered services for the rest of the plan year.
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Wellcare of Tennessee Medicare Advantage plans terminated
Vanderbilt Health in Nashville, TN, accepts a variety of insurance plans, including Medicare Advantage. However, it's important to note that not all Medicare Advantage plans are accepted. For example, Vanderbilt University Medical Center (VUMC) has stopped accepting Blue Cross' Medicare Advantage plan. This change is part of a broader trend of providers dropping Medicare Advantage groups, with at least 25 providers nationwide making similar decisions, according to Becker's Hospital Review.
Wellcare, on the other hand, offers Medicare Advantage Plans in Tennessee. They provide a range of options, including HMO, PPO, and Special Needs Plans. However, it is not clear whether Vanderbilt Health accepts Wellcare's Medicare Advantage Plans. Wellcare emphasizes the importance of finding a provider that accepts their plans, suggesting that not all providers participate in their network.
Wellcare of Tennessee appears to offer a range of Medicare Advantage Plans for 2025. They encourage prospective members to compare plans and enroll. However, it is unclear whether these plans have been terminated or are still active. The website provides tools to find providers and pharmacies, indicating that they have a network of participating healthcare providers.
It is important to note that insurance plan acceptance can change over time. While Vanderbilt Health and Wellcare may have had agreements in the past, it is always advisable to verify the most up-to-date information directly with the hospital or insurance provider. Contacting Vanderbilt Health or referring to their website will provide the most accurate and current information regarding their accepted insurance plans.
In summary, while Vanderbilt Health accepts Medicare Advantage plans, specific plans like Blue Cross' Medicare Advantage have been terminated. Wellcare offers Medicare Advantage Plans in Tennessee, but it is unclear if Vanderbilt Health accepts these specific plans. It is essential to stay informed about the latest developments by directly contacting the relevant parties.
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Vanderbilt Tullahoma-Harton Hospital out-of-network plans
Vanderbilt Tullahoma-Harton Hospital, part of the Vanderbilt Health community of hospitals and clinics, offers a wide range of inpatient and outpatient medical and surgical services. As of January 1, 2021, the hospital is out of network for some insurance plans.
The hospital accepts several UnitedHealthcare Group Medicare Advantage Plans, including UnitedHealthcare Medicare Complete/AARP UnitedHealthcare (excluding Oxford HMO and Pacificare), UnitedHealthcare Options PPO, and UnitedHealthcare Dual Complete Plans (Medicare/Medicaid).
However, Vanderbilt Tullahoma-Harton Hospital is excluded from certain networks. For example, it is excluded from Network L along with VBH and VTHH for Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage. Additionally, it is out of network for UnitedHealthcare COMPASS (Individual Exchange Plan) and UnitedHealthcare Complete (C-SNP).
It is important to note that insurance plan acceptance can change over time. Therefore, patients should refer to the hospital's website or contact their insurance provider directly for the most up-to-date information regarding accepted insurance plans and any potential out-of-network status.
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Frequently asked questions
Yes, Vanderbilt Health covers some Medicare Advantage plans. However, it does not accept out-of-network benefits offered through these plans, excluding emergent needs.
Vanderbilt Health does not accept Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage. As of April 1, 2023, Vanderbilt University Medical Center (VUMC) also terminated its participation with specific Medicare Advantage plans offered through Humana and Wellcare of Tennessee.
Yes, Vanderbilt Tullahoma-Harton Hospital accepts Wellcare Medicare Advantage and Cigna (aka HealthSpring) Medicare Advantage plans.
No, Vanderbilt University Medical Center (VUMC) has stopped accepting Blue Cross' Medicare Advantage plan.
Yes, Vanderbilt Health accepts Cariten Medicare Advantage plans. However, it is important to note that Vanderbilt University Medical Center and its Affiliates are out-of-network participants and cannot accept out-of-network benefits offered through this plan, excluding emergent needs.
