Humana
Humana is also a leading cause of physician dis-satisfaction. They are one of the worst when trying to get tests ordered for patients. We spend more time with preauthorization, denials, appeals and phone calls then we do with any other company.
Patient care suffers because of delays and denials. In addition, they are routinely one of the companies that continually reimburses lower than medicare rates.
The corporate CEO and executive salaries are listed in these reports.
We have begun the process of negotiating with them, but once again face the same obstacles of having minimal leverage.
We sent Humana 3 independent fee schedules from three of our better payors. Their email response was as follows:
Laura,
The two major payors that we look at are United and Anthem. Without asking for specifics, are these rates representative of either of those payors?
Thank you,
Darin Lancaster
Provider Contracting
Humana Kentucky Market
(502) 580-5014
Dlancaster1@humana.com
As you can see, they are not interested in anything other than United and Anthem. As long as the three of them can manipulate the fee schedules, they will retain the largest market share.
If physicians did this, we could be charged with collusion.
posted by Anonymous at 6:12 AM
2 Comments:
Price following does not equal collusion. Here's an interesting question for you. As an employer, who have you chosen to be your employees' health insurer and why?
The issue of price following and collusion has been before the US Supreme Court in several cases over the years -- the steel mills all having the same price for steel and commercial banks all having the same Prime rate are a couple that come to mind. They have always ruled that the test for collusion is much greater than mere price following. Otherwise, every gas station in the country would be in trouble.
There was The Physician's Inc., which was called TPI which I believe attempted to negotiate on behalf of providers. Last I heard, it's defunct.
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