Medicare Advantage Plans Change 2023

Some Medicare Advantage Plans To Be Out of Network for Care at Vanderbilt Health as of April 1

After a careful review of our contracted Medicare Advantage plans, we've made the difficult decision to end our participation with Humana and Wellcare Medicare Advantage plans. This change will be effective April 1, 2023.

Health systems across the country, including Vanderbilt Health, face higher costs for personnel, supplies, equipment and medications needed to provide high quality care for all patients. 

Vanderbilt Health can't continue to partner with Medicare Advantage plans that don't provide adequate payments to sustain these increased costs.

We understand this situation may be stressful. Please know that until then, nothing changes. Patients may continue to access their trusted Vanderbilt Health provider or facility without disruption until April 1, 2023.

It is only after March 31 that patients will lose in-network access to the following Vanderbilt Health hospitals, clinics and affiliated partners.

  • Vanderbilt University Hospital
  • Vanderbilt Health Clinics throughout the region
  • Vanderbilt Psychiatric Hospital
  • Vanderbilt Wilson County Hospital
  • Vanderbilt Bedford Hospital
  • Vanderbilt Tullahoma-Harton Hospital
  • Vanderbilt Home Care Services
  • Cool Springs Surgery Center*
  • Spring Hill Surgery Center*
  • Vanderbilt Imaging Services*
  • Vanderbilt-Ingram Cancer Center at Tennova Healthcare (Clarksville)*
  • Vanderbilt-Ingram Cancer Center at Maury Regional Spring Hill*

* An affiliated partner

What should I do if I'm affected by this change?

  • Review the information on this page, including the list of common questions below.
  • Speak to your insurance broker or advisor about your options for another plan.
  • Call the number on your insurance card for help finding in-network providers.
  • Request your medical records online, using My Health at Vanderbilt account or with our medical record online request form.
  • Request your medical records by phone. Find numbers for Vanderbilt Health hospitals and clinics.

Note that if you are requesting records from certain affiliated partners, you'll need to contact them directly. You'll find that list with phone numbers in the common questions below or in the instructions in the box at the right if you're viewing on desk- or laptop. This box is located below the common questions if you're viewing this page on your phone.

Common Questions About This Change

Please review the questions below. If you don't find an answer to your question here, call 855-429-2989.

  • After careful review of Medicare Advantage plans, Vanderbilt Health has made the difficult decision to end participation with Medicare Advantage plans offered by these health insurers. This change is effective on April 1, 2023.

    These changes are needed for Vanderbilt Health to continue its mission, honor commitments to its workforce, and continue to grow to meet community needs.

    If you're affected by these changes, you can continue to get care at Vanderbilt Health hospitals, clinics or other facilities through March 31.

     

  • Health systems like Vanderbilt Health continue to face higher costs for personnel, supplies, equipment, and medications needed to provide high quality care.

    We rely on fair partnerships with insurance companies that help us cover these increased costs. We can't continue to partner with insurance plans that don't reimburse us adequately.

     

  • Beginning April 1, 2023, affected Vanderbilt Health hospitals, clinics and affiliated partners will no longer participate in Humana or Wellcare Medicare Advantage plans.

    You may continue to access and receive care at any of Vanderbilt Health hospitals, clinics, or other facilities through your existing Medicare Advantage plan until this date.

  • Beginning April 1, 2023, the following Vanderbilt Health hospitals, clinics and affiliated partners will no longer be covered by Humana or WellCare Medicare Advantage plans:

    • Vanderbilt University Hospital
    • Vanderbilt Health clinics throughout the region
    • Vanderbilt Psychiatric Hospital
    • Vanderbilt Wilson County Hospital
    • Vanderbilt Bedford Hospital
    • Vanderbilt Tullahoma-Harton Hospital
    • Vanderbilt Home Care Services
    • Cool Springs Surgery Center*
    • Spring Hill Surgery Center*
    • Vanderbilt Imaging Services*
    • Vanderbilt-Ingram Cancer Center at Tennova Healthcare (Clarksville)*
    • Vanderbilt-Ingram Cancer Center at Maury Regional Spring Hill*
       

    * An affiliated partner 

  • Only Humana and Wellcare Medicare Advantage plans are affected.

    See all accepted insurance plans here. Note that the Humana and Wellcare plans are still listed because they're accepted through March 31. 

  • Yes. However, Vanderbilt Health will continue to honor its obligations to its transplant patients and work diligently with your insurance plan to arrange for your continued care for a period of time.

    See answers to common questions specific to transplant patients.

     

  • Vanderbilt Health will provide for your care for a period of time, until you are formally released from our care.

  • Yes, all Vanderbilt Health doctors, surgeons and advanced nurse practitioners, are affected.

    In addition, community health care providers who aren't employed by Vanderbilt but who perform procedures at any of the impacted facilities may be affected.

    Talk to your health care providers about your specific situation.

  • Contact your insurance broker or benefits adviser for more information about Medicare plans and this year’s Open Enrollment period.

    Your broker or advisor is the best person to discuss with you options to consider to meet your needs. That's their area of expertise. As a patient care provider, Vanderbilt Health is not able to guide you in this decision.

    If you need to reschedule an appointment or request your medical records, see related questions. 

  • If you need to request a transfer of your medical records from Vanderbilt Health hospitals and clinics:

    If you're a patient at one of the following affiliated partners, you may request your medical records by calling them directly:

    • Cool Springs Surgery Center: 615-468-2684
    • Spring Hill Surgery Center: 931-489-2644
    • Vanderbilt Imaging Services: 615-352-1975
    • Vanderbilt-Ingram Cancer Center at Tennova (Clarksville): 931-221-0479
    • Vanderbilt-Ingram Cancer Center (radiation oncology) at Maury Regional Spring Hill: 931-380-1194

     

  • As of April 1, visits to these walk-in clinics will be out of network for any patient with these Medicare Advantage plans.

  • To make or reschedule an appointment before April 1, call the clinic or reschedule or make your appointment online through My Health at Vanderbilt.

  • Call your doctor's office or cancel your appointment online using My Health at Vanderbilt.

  • Call the member services number on the back of your insurance ID card with that question.

  • Call the member services number on the back of your insurance ID card to ask about providers who are in network under your plan. 

  • Contact your insurance broker or benefits adviser for more information about the ability to switch plans.

  • Yes, until you are released from care by your provider.

  • We don't expect prescriptions written by Vanderbilt Health providers to be impacted. But we recommend you verify your prescription drug coverage. 

    • For retail pharmacy locations, call Vanderbilt Pharmacy at 615-322-6480.
    • For specialty medications, call Vanderbilt Specialty Pharmacy at 615-875-0080.
    • Contact your pharmacists through My Health at Vanderbilt or the VUMC Rx App on your mobile phone.
  • Emergency rooms provide lifesaving and stabilizing care to all patients for urgent or emergency needs regardless of insurance coverage. If you think you have a medical emergency, please go to the closest emergency room.

  • These plans are purchased as a group and the decision about which plans to offer is made by the plan manager. A single participant can't make their own decision to switch plans. 

    Humana and Wellcare Medicare Advantage plans will be out of network with Vanderbilt Health on April 1. If you have coverage with these plans as part of group, you should contact your insurance plan for assistance before April 1. 

    Your broker or advisor is the best person to discuss with you options to consider to meet your needs. That's their area of expertise. As a patient care provider, Vanderbilt Health is not able to guide you in this decision.