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In the past three years, Queen\u2019s has served 11,000 Medicare Advantage patients covered by Humana, with services ranging from simple X-rays to full-fledged hospital stays. (Craig Fujii\/Civil Beat\/2025)<\/p>\nThe contract dispute with Humana highlights broader health system woes.<\/p>\n
The Queen\u2019s Health Systems has notified patients with Humana Inc. medical insurance that they soon may need to find a new doctor or get new health insurance.\u00a0<\/p>\n
Queen\u2019s, one of Hawai\u02bbi\u2019s largest health systems with six hospitals statewide, will no longer have a contract with Humana as of March 19, Queen\u2019s wrote in a letter to patients earlier this month. That means Queen\u2019s won\u2019t accept Humana insurance, and patients who have it won\u2019t be able to see Queen\u2019s doctors or visit its hospitals \u201cwithout administrative or financial impact.\u201d<\/p>\n
Humana, a Kentucky-based, publicly traded medical insurer, offers Medicare Advantage plans in Hawai\u02bbi. Such plans are funded by the federal government, which provides private insurers a fixed, monthly payment per month for enrollees. The insurers pool the money and then sell policies to elderly customers, promising to cover their medical care.\u00a0<\/p>\n
In the past three years, Queen\u2019s has served 11,000 Medicare Advantage patients covered by Humana, with services ranging from simple X-rays to full-fledged hospital stays. (Craig Fujii\/Civil Beat\/2025)<\/p>\n
Neither Queen\u2019s nor Humana would say what has caused the rift. Humana has been accused elsewhere of wrongly refusing to pay for services<\/a> needed to treat its policyholders. <\/p>\n A spokesperson for Humana said in a written statement that the company is communicating with Queen\u2019s to find a solution. Queen\u2019s executive vice president of clinical integration and chief physician executive, Dr. Whitney Limm, said Queen\u2019s is \u201copen to discussion to minimize disruption to patient care.\u201d<\/p>\n In the past three years, Queen\u2019s has served 11,000 patients covered by Humana, with services ranging from simple X-rays to full-fledged hospital stays, Limm said. While that represents only about 2% of the 550,000 patients Queen\u2019s served in the period, Limm said the Humana patients, like others on Medicare, tend to have more severe health problems than the general population and thus require greater, more expensive care.<\/p>\n The dispute comes as Hawai\u02bbi\u2019s health care system faces serious challenges: rising treatment costs and lower insurance reimbursements for doctors and hospitals, increasing insurance premiums and co-payments for employers and patients, and a\u00a0shortage of doctors<\/a> serving an archipelago state. That\u2019s created a snarl of interrelated, complex issues that result in people not being able to get the care they need.<\/p>\n The situation has led two of the state\u2019s largest health care companies \u2014 the nonprofit hospital and clinic giant\u00a0Hawai\u02bbi Pacific Health<\/a>\u00a0and nonprofit insurer\u00a0HMSA<\/a>\u00a0\u2014 to propose a new partnership to integrate insurance and patient care under an umbrella entity to reduce administrative costs and increase efficiency. But Queen\u2019s has criticized the proposal, saying it would financially batter the Queen\u2019s system, which serves as a nonprofit safety net for a large share of uninsured, Medicare, Medicaid and Native Hawaiian patients.<\/p>\n Meanwhile, for-profit insurers have been accused<\/a>\u00a0of addressing rising health care costs by denying coverage, delaying it and reducing reimbursements by reclassifying procedures, known as down-coding in medical parlance.<\/p>\n Lawsuit: Humana Used AI To Deny Coverage <\/p>\n This dark side of the for-profit health insurance business came into focus in late 2024, when\u00a0former Hawai\u02bbi resident Luigi Magione allegedly shot and killed UnitedHealthcare CEO Brian Thompson<\/a>\u00a0in New York City. Awaiting trial, Mangione has become a\u00a0cause celebre<\/a>\u00a0for social activists and people who have fought their own battles against insurance companies.<\/p>\n Humana faces a federal class-action lawsuit alleging it has illegally used artificial intelligence programs in place of doctors \u201cto wrongfully deny elderly patients care owed to them under Medicare Advantage Plans.\u201d That has allegedly left its elderly customers with the grim choice of foregoing needed care or paying for it out of their own pockets, if they can.<\/p>\n Limm declined to comment on the specifics of the Queen\u2019s contract with Humana. But generally, he said, points of friction between providers like Queen\u2019s and insurers like Humana center on two areas: claims processing, which involves the time it takes for payers to issue reimbursements to providers, and utilization management, an umbrella term for how providers and payers decide which treatments are needed and will be paid for by the insurers.\u00a0<\/p>\n Limm said it\u2019s Queen\u2019s Health System\u2019s mission to continue to provide healthcare services to the community.\u00a0<\/p>\n \u201cThe question,\u201d he said, \u201cis how do we work with the payers to put us in a position to provide them.\u201d<\/p>\n
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