Bon Secours has issued a public notice to patients covered by Humana's managed Medicaid and Medicare Advantage plans, warning that the healthcare provider may become an out-of-network service if a new agreement is not reached. The current contract is set to expire, and without a resolution by January 1, 2026, thousands of patients could face higher medical costs.
The healthcare system confirmed it is in active negotiations with the insurance giant. The outcome of these discussions will determine whether patients in several regions can continue to receive in-network care at Bon Secours facilities.
Key Takeaways
- Negotiation Deadline: Bon Secours and Humana must reach a new agreement by January 1, 2026, to avoid a contract termination.
- Affected Plans: The potential change impacts patients with Humana Managed Medicaid and Humana Medicare Advantage insurance plans.
- Potential Impact: If no deal is made, Bon Secours facilities and many of its providers will be considered out-of-network, leading to significantly higher out-of-pocket costs for patients.
- Current Status: Both parties are currently engaged in active negotiations, with Bon Secours stating a commitment to finding a fair resolution.
Details of the Contract Dispute
Bon Secours, a major healthcare provider in several states, is currently renegotiating its contract with Humana, one of the nation's largest health insurance companies. These negotiations are standard in the healthcare industry, as providers and insurers periodically review and update the terms of their agreements, including reimbursement rates for medical services.
However, the discussions have reached a critical point where a failure to agree on new terms is a real possibility. In a statement, Bon Secours emphasized its dedication to its patients. "Your health is our priority, and we’re doing everything we can to maintain your in-network access to the Bon Secours facilities and caregivers you know and trust," the provider stated.
The central issue in these disputes typically revolves around the cost of care. Healthcare providers like Bon Secours seek reimbursement rates that they believe reflect the value and quality of their services, while insurers like Humana aim to control costs to keep premiums affordable for their members.
Why Do These Negotiations Happen?
Contracts between healthcare providers and insurance companies are not permanent. They are typically set for multi-year terms. When a contract nears its expiration, both sides negotiate new terms. These talks cover everything from which services are covered to how much the insurer will pay the provider for each procedure, visit, and test. If they cannot agree on pricing and other terms, the contract may be terminated, forcing patients to either switch doctors or pay much more for their care.
What This Means for Patients
For patients with Humana's Managed Medicaid or Medicare Advantage plans, the potential contract termination could have significant financial and logistical consequences. If Bon Secours becomes an out-of-network provider, patients seeking care at their facilities would be responsible for a much larger portion of their medical bills.
Understanding In-Network vs. Out-of-Network Costs
When a hospital or doctor is "in-network," it means they have a contract with an insurance company to provide services at pre-negotiated, discounted rates. Patients pay their standard copay, deductible, and coinsurance.
When a provider is "out-of-network," no such agreement exists. Patients are often required to pay the full, non-discounted cost of services upfront and then seek partial reimbursement from their insurer. This reimbursement is often a small fraction of the total bill, leaving the patient with substantial out-of-pocket expenses.
The Financial Impact of Out-of-Network Care
According to studies on medical billing, the cost for the same medical procedure can be three to five times higher at an out-of-network facility compared to an in-network one. For a major surgery or extended hospital stay, this could translate to tens of thousands of dollars in unexpected bills for a patient.
Continuity of Care Concerns
Beyond the financial strain, a network change can disrupt ongoing medical treatment. Patients with chronic conditions, those undergoing long-term treatment like chemotherapy, or pregnant patients may have to find new specialists and transfer their medical records, which can be a stressful and complicated process.
"We are committed to a fair resolution that ensures you and your family continue receiving the high-quality care you deserve."
Bon Secours Official Statement
Which Locations and Plans Are Affected?
The negotiations between Bon Secours and Humana are specific to certain plans and geographic areas. It is crucial for patients to understand whether their specific plan and location are part of this potential change.
The primary focus of the notice is on patients in the Richmond, Virginia area. However, the impact extends to other regions as well.
Unaffected Locations
Bon Secours has clarified that some of its facilities will not be affected by these specific negotiations. These include:
- Facilities in Charleston, South Carolina
- Roper St. Francis Healthcare providers
- St. Francis Eastside hospitals in Greenville, South Carolina
Potentially Affected Providers
While some hospitals in Greenville, SC, are safe, the statement noted that employee providers in Greenville could be impacted. This distinction means that while the hospital building itself might remain in-network for other reasons, the doctors, specialists, and other medical staff who treat patients there might not be.
Patients are strongly encouraged to verify the status of their specific doctors and facilities. Bon Secours has directed individuals to its official website for the most current and detailed information regarding the negotiations.
What Patients Should Do Now
While the January 1, 2026, deadline is still several months away, patients are advised to begin preparing for a potential change. Both Bon Secours and Humana have a strong incentive to reach an agreement to avoid disrupting patient care and losing business, but outcomes are never guaranteed.
Steps for Humana Members
- Confirm Your Plan: First, verify that you have a Humana Managed Medicaid or Medicare Advantage plan. Other commercial or employer-sponsored Humana plans may not be affected.
- Stay Informed: Check the Bon Secours and Humana websites regularly for updates on the negotiation status. Official announcements will be posted there.
- Understand Your Options: Begin researching other in-network healthcare providers in your area as a backup plan. Humana's website should have a directory of participating doctors and hospitals.
- Contact Humana: Patients can call the member services number on the back of their insurance card to ask questions and express their concerns about maintaining access to Bon Secours.
As the deadline approaches, both organizations will likely provide more information. For now, the situation remains fluid, with thousands of patients waiting to see if they will need to make difficult decisions about their healthcare in the new year.
