whopper

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I have several patients in private practice who have Humana but I'm still working on getting on their insurance panel. As a result, those patients have to pay out of pocket.

It turns out (at least according to a form I got from Humana) that the only way they'll put me on their insurance panel is if I work in a hospital that's on some type of list of Humana "lifesource" (or something that sounds like that) hospital. I'm already in two hospital systems, both of which are not in the Humana system. The other way to get on is I have to find a doctor who works in an inpatient unit that is part of the Humana system that has to take my patients should that person need inpatient treatment.

Anyone find this weird? 1) A patient may need to go to the hospital and have no say in which hospital they go. It's often up to availability of the bed and determined after they go to the ER 2) The hospitals I'm already in are highly respected institutions, yet they're not on this system they speak of (at least according to them--but hey, it's their list) 3) No psychiatrist in the area in private practice takes Humana, and it seems like it's because of this reason.

I'm thinking that this may in effect may Humana very user-unfriendly when it comes to those in need of mental health treatment in the community. Anyone else with experience in this?

They're also giving me some bull that I'm a cardio-thoracic surgeon and they have a problem understanding why I want to practice psychiatry. Yeah, I know. I gave them my CV, a copy of my state license, and no I'm not a cardio-thoracic surgeon in addition to a psychiatrist. Then they answer, "No, you're a cardiothoracic surgeon, our records verify this." I ask them to give me their records but they state they will not becuase its "their" records.

Talk about insurance company bull$hit.
 

billypilgrim37

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They're also giving me some bull that I'm a cardio-thoracic surgeon and they have a problem understanding why I want to practice psychiatry. Yeah, I know. I gave them my CV, a copy of my state license, and no I'm not a cardio-thoracic surgeon in addition to a psychiatrist. Then they answer, "No, you're a cardiothoracic surgeon, our records verify this." I ask them to give me their records but they state they will not becuase its "their" records.

Talk about insurance company bull$hit.
This has to earn you a free subscription to the Placebo Journal.
 

tishage

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humana provides horrible mental health coverage. ive had multiple psychiatrists advise me to advise my pts to choose another insurance carrier bc of their negative experiences w/ humana. i had a pt who was put on a 72 hr hold and then hospitalized involuntarily and despite both the PES and inpt psychiatrist attesting for this pt's need to be hospitalized, a humana representative determined that she didnt meet criteria for acute hospitalization over the phone and they refused to cover any of her $18,000 bill. i wrote a letter to humana about their growing negative reputation and need to change their policy for their own interests, but no response.
 

loveoforganic

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clearly you should start padding your income with open heart surgery billing...
 

michaelrack

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.

I'm thinking that this may in effect may Humana very user-unfriendly when it comes to those in need of mental health treatment in the community. Anyone else with experience in this?
.
Most cigna plans in MS require specialists (including psychiatrists) to be on staff at one of the 2 main hospitals in MS- Baptist (Jackson, MS) or St. Dominic's.

Regarding your experience, in addition to Humana perhaps trying to be user-unfriendly, the hospital Humana is in network with is probably influencing the policy. The hospital is able to essentially force some psychiatrists to be on staff at their hospital.
 
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whopper

whopper

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Did I also mention that my office manager and I were on the phone over 5 hours over this? I was on the phone thinking after 5-10 minutes of conversation I could clear up that I'm not a cardiothoracic surgeon. After 40 minutes of being transferred to 7 people, all of which told me they were not the person to talk to and then transferring me to the next person, claiming that person was the person to talk to, then that person saying she was not the person to talk to, and then transferring me to someone else......

After 10 minutes, I became ticked and went into pit-bull mode. I decided I'd stick on this. After 40 minutes, I realized this was becoming a lesson in futility and told my office manager to take over. I started thinking that I should try this again with a reporter from a news network to expose this type of practice that's going on. I haven't hit that nerve yet.....

All of this sounds like insurance company intentional side-stepping in the hope it'll prevent someone from getting their bill paid by an insurance company that is supposed to provide coverage for a legitimate treatment for a legitimate condition.

I, like probably all of you, when asked which insurance company I wanted to take had no idea which was better or worse. This is the first signs of me thinking that Humana is definitely a company to avoid. If this issue doesn't clear up soon, I'm going to start telling friends and family to avoid that insurance company.

As for my patients, telling you just of one of them, that person has had to pay over $1000 in out of pocket costs because of this issue that should've been picked up by the insurance company. I'd hate for anyone to be in a position where they had insurance and even though the insurance is supposed to pay for mental health treatment, they found some loophole to get out of it.

the hospital Humana is in network with is probably influencing the policy.
Sounds like a cabal to me. No psychiatrist in their right mind is going to agree to become another doctor's specific inpatient doctor when the system isn't designed for a patient to go to a specific inpatient doctor and most doctors don't have enough of a relationship to know the quality of the practice of the other doctor.
 
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OldPsychDoc

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