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A resolution conveying the Metropolitan Council’s request that Vanderbilt University Medical Center and Humana, Inc. resolve their dispute regarding reimbursement rates expediently and in such manner as to maintain current services for all Metropolitan Government employees, retirees, and pensioners, and others throughout Davidson County, without disruption.
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WHEREAS, Vanderbilt University Medical Center is the largest comprehensive research, teaching, and patient care health system in the Mid-South area, with over 1,700 licensed hospital beds across seven hospitals that sees more than three million patient visits per year; and
WHEREAS, Humana, Inc. is a for-profit American health insurance company based in Louisville, Kentucky. In 2021, the company ranked 41 on the Fortune 500 list and has been rated as the third largest health insurance provider in the nation; and
WHEREAS, on January 9, 2023, the Employee Benefit Board for the Metropolitan Government of Nashville and Davidson County was informed that Vanderbilt University Medical Center (VUMC) had notified Humana, Inc. that as of April 1, 2023, VUMC will no longer participate in Humana Medicare Advantage plans (Group and Individual) and Commercial Group plans as the result of reimbursement rate disputes; and
WHEREAS, VUMC is engaged as a significant provider in most network health care plans for Metropolitan Government employees, retirees, and pensioners; and all Metropolitan Government pensioners post-65 are enrolled in the Humana Medicare Advantage Plan; and
WHEREAS, any decision to terminate participation in the Humana Medicare Advantage Plans could pose sudden, drastic, and potentially harmful consequences for the valued pensioners and dependents within the Metropolitan Government. Additionally, termination could pose significant consequences for beneficiaries throughout Davidson County who are age 65 and over and who rely upon Humana Medicare Advantage for healthcare services; and
WHEREAS, VUMC has provided invaluable services under the Medicare Advantage Plan by allowing for services through in-network providers; and
WHEREAS, on January 10, 2023, Mayor John Cooper contacted representatives from Vanderbilt University Medical Center and Humana, Inc. requesting that both parties resolve their reimbursement dispute quickly in such manner as to preserve current healthcare services and coverage for Metropolitan Government employees, retirees, and pensioners - as well as all Davidson County residents receiving such coverage -- without disruption; and
WHEREAS, it is in the best interests of the citizens of Nashville and Davidson County that Vanderbilt University Medical Center and Humana, Inc. resolve any disputes expediently and without affecting the vital healthcare services provided to employees, retirees, and pensioners of the Metropolitan Government and others throughout Davidson County.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON COUNTY:
Section 1. That the Metropolitan County Council hereby goes on record as requesting that Vanderbilt University Medical Center and Humana, Inc. endeavor to resolve any disputes regarding reimbursement rates expediently and in such manner as to maintain current services for all Metropolitan Government employees, retirees, and pensioners - and all Davidson County residents -- without disruption.
Section 2. That the Metropolitan County Council further goes on record as requesting that, in the event the above-references negotiations are not successful, both parties allow for continued services by Vanderbilt University Medical Center to all Metropolitan Government Humana Medicare Advantage beneficiaries, billing for such services as an out-of-network provider on a non-par basis.
Section 3. This Resolution shall take effect from and after its adoption, the welfare of The Metropolitan Government of Nashville and Davidson County requiring it.