Thursday, March 28, 2013

Asking Center for Medicare & Medicaid Services Administrative Offices to Tackle lack of Mental Health Care for Humana's Insured

e mail letter sent to Administrative Offices of CMS w/ cc to Senator Hagen (liason: Anna Abram) and Senator Burr (liason: Karen Wade) re: (obvious) change in contract between Humana and CMS regarding mental health care/ Part B for NC citizens w/ mental health needs

".........Specifically, this is the problem: Humana, a Medicare Advantage
company, whose clients I have been seeing and reimbursed for
seeing----for years----has apparently, without notice, changed its PPO
policy such that I can no longer provide services to their clients.  I
have seen Humana PPO clients for the past five years.

The company managing Medicare in NC is Palmetto.  They have no information.
Humana has no information except to say that I now have to be
"In-Network" whileas before by being a Medicare Provider of many
years, I was able to work w/ this Medicare Advantage company.
Palmetto personnel indicated that the Part B's of these companies,
such as Humana and United Health Care (had the same problem last year
regarding one of their insured) are largely unregulated.

The NC Insurance Commissioners Office was not helpful.  They believe
that I am supposed to be an In-Network provider and they had no
information about how to deal w/ this matter. Again, Humana will not
allow me to become an In-Network provider.

***Does this not violate some part of the contract which must have
been recently changed vis a vis CMS and Humana?***

Why doesn't the NC Insurance Commissioner's office not guide citizens
with mental health concerns to avoid the Medicare Advantage companies
given the company's Part B unhelpful changes?

How is it that citizens who have mental health challenges are
challenged to come up with solutions that citizens with medical
illnesses as associated with Part A Medicare ----are never required to
address? There is supposed to be mental health parity.  There is no

Thank you for your response.

Marsha V. Hammond, PhD  NPI 1194700591Clinical / Health Psychology


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