Thursday, June 06, 2013

Humana's Life Sync (Manager of MH Benefits) Doesn't Realize They Can Check Status of License of Providers online


No one should move away from Medicare and if you're insured by a Medicare 'Advantage' company, you best get back to Medicare ASAP.

Here is my correspondence with a Life Sync person.

The problem with having all these different companies instead of a centralized insurer LIKE MEDICARE is that they all have their little petty rules created by people who don't even realize that they can use a computer to check the status of one's license.

Oh, that reminds me of a joke re: the late Western Highlands Network LME (the one that the Smoky Mountain Center LME says on their website that they're 'joyfully' working with): in the beginning of their recredentialing, they asked for an official college transcript.  I complained.  They pulled the demand.

But I gotta say that I get tired of teaching the people who should know what they're doing---what to do.


Kimberly Harville
May 24 (13 days ago)
to me
Good Afternoon,

I pulled your CAQH application online and it looks like your attestation is expired. Could you contact CAQH and reattest with them? Also, could you send me a copy of your W9 and license?

Thank you,

Kimberly Harville
Physician Contractor | Provider Development

LifeSyncha Humana company

June 6, 2013                                           **************************

Dear. Ms. Harville (of Life Sync, manager of Humana's Behavioral Health Services):
I will mail you the W9.  Thanks for the address. 
I have no intention of trying to hack my way thru your system anymore than is necessary as pertaining to this matter: "If you want specific benefits for any members, you would have to contact eligibility and benefits."
As I said, I recommend to all my clients that stay on or return to MEDICARE.  Indeed, any case manager at any hospital will tell you the same story.  
I am waiting to hear from CMS re: my request for investigation of why Humana has harassed my clients---and me indirectly----re: all of a sudden as of Jan 1, 2013, I have to be 'in network.'  This was NEVER an issue in years past.  And I want to know why there is a 'stated' $500 deductible for out of network mental health providers---such as myself----when there was nothing of the kind in previous years.  Not surprisingly, this deductible disappears when the insured calls you up.  So, what's that about? 
You changed the rules and I intend to find out what sort of contracting maneuvering took place between CMS and Humana, etc., the other Medicare 'Advantage' companies. 
Marsha V. Hammond, PhD, Licensed Psychologist, NC

June 5, 2013

Dr. Hammond,

If you wish to mail the W9, you can mail it to 2101 W John Carpenter Frwy, Irving, TX 75063 attention Kimberly Harville. You may fax or email this if it’s easier for you. I will pull your license online.

I received a request in April that you wanted to join our network. On April 29th, I emailed you our contract and credentialing documents needed to start the process to credential you into our network. We need a contract, W9, and either an application or complete and up to date CAQH application for all providers wanting to credential with LifeSynch and Humana for behavioral health. We cannot process your application until we have all the necessary documents.

You are correct, LifeSynch manages Humana’s behavioral health contracts; we have for about 5 years now. To be paid at in network rates, and to be able to see our members and allow for them to use their in network benefits, you must be credentialed and in network with LifeSynch.

As far as any benefit information, including deductible, I am unsure of. I handle provider contracting and do not have access to any member plan or benefits. If you want specific benefits for any members, you would have to contact eligibility and benefits.

Thank you,

Kimberly Harville
Physician Contractor | Provider Development

LifeSyncha Humana company
2101 W John Carpenter Frwy | Irving, TX 75063


June 3, 2013

Dear Kimerly Harville of Humana: 

BTW: I need your address to send you the W9 and a copy of my license which is easily found at the NC Psychology Licensing Board.

Prior to January 1, 2013, Humana's Behavioral Health Services, which have been managed by LifeSync in Dallas for a number of years now, did not require me to be in-network as I am a Medicare provider and Humana is supposedly a 'Medicare Advantage' company.  

Something changed, causing me to have to create another set of paperwork e.g., you asking for my CAQH (I updated it); you asking me for a W-9 (never had to do this before); you asking for a copy of my license (look at the NC Psychology licensing board website if you want to see if I am current).  

Additionally, my Humana clients, whether Humana PPO Choice or Humana (standard) have all been told that there is a $500 deductible re: behavioral health.  

Well, it appears that I have created enough of a stink by asking for an investigation by CMS that lo and behold, I am getting Humana checks in the mail.  

In other words, the left hand of your company does not know what the right hand is doing.  

That's a real problem for providers and your insured.  We get tired of calling you up on the phone and sending in paperwork.  

If Humana is no longer a Medicare Advantage company (with Medicare requiring a 
$200 overall deductible at the beginning of every calendar year), then you should tell your insured and the providers who have been seeing your insured. 


Marsha V. Hammond, PhD, Licensed Psychologist, NC

June 2, 2013

Thank you Dr. Hammond. I’ve pulled your CAQH application.

When you refer to the additional tier of credentialing, are you referring to LifeSynch? I’m not sure I understand your question.

Thank you,

Kimberly Harville
Physician Contractor | Provider Development
June 1, 2013
Hello Ms. Harville: 

On its way. I had believed I had recently re-attested re: CAQH.  

BTW: If Humana is a Medicare Advantage company, how is it that they are allowed to create another tier of credentialing?  These problems did not surface until Jan 1, 2013.  I encourage all my Humana clients to return to regular Medicare re: these hassles. 

I have made an inquiry to CMS re: this matter.  


Marsha V. Hammond, PhD


Saturday, June 01, 2013

Continuing to Ask CMS (Centers for Medicare & Medicaid Services) to Investigate Humana mental health $500/ year deductible for Previously In-Network Providers

Here is the (obvious) reason why Humana is creating barriers to mental health care as associated with the $500 deductible/ year for previously In-Network Medicare providers: 

Report Shows Better Outlook for Medicare

"....The Medicare trustees — four federal officials and two public representatives — said in their annual report that the “modest improvement” in the outlook for Medicare’s long-term finances reflected lower projected spending for skilled nursing homes and private Medicare Advantage plans."

Yes, your tax payer money has been paying private enterprise, such as Humana, and the other Medicare 'Advantage' companies to stay in business.  Your tax $$ have been lining the pockets of private CEO's and their employees.  And now, in order to keep making money-----since the jig is up re: continuing to keep them afloat with their 15+% administrative oversight fees----versus Medicare's 5% administrative oversight fees----they will do whatever it takes to create barriers to care.  

Here is the letter I wrote today following up on my complaint about Humana pretending to be a Medicare Advantage company.  

"Dear CMS Investigator (telephone number: 410 786 1047: Tilghman, Cornell C. (CMS/CMM) ): 

I have not heard a word re: my complaint associated with ALL of my Humana clients being required to have a $500 deductible for mental health services as Humana as of January 1, 2013 required me to be 'in network' though in years past----as they are purportedly a "Medicare Advantage" company----there was no issue.  As you know, Medicare requires a $200 deductible for ALL medical and mental health services at the beginning of every year.  

Therefore, why does Humana require----ONLY FOR MENTAL HEALTH CARE BEST I KNOW-----a $500 deductible before I am paid below the rate for Medicare? 

Yes, I have turned in all my paperwork to become an In Network Humana provider but Humana never advised me that this was necessary.  I had to discover the matter when my claims were not paid.  

I have a complaint; I want a solution and an answer.  And I want to be paid for my work that has been done as I was never advised by Humana about this change.  And neither were my clients-----unless they perhaps had bothered to read every single piece of fine print sent to them by Humana.  I am informed that Humana sends out several letters a week to clients.  They simply cannot keep up w/ this deluge of information whose obvious intention is to disallow them from discovering changes that Humana has made. 

I am awaiting the response from CMS (Centers for Medicare and Medicaid Services) please and was assured a month ago that I would have a response by now.  

Thank you.  

Marsha V. Hammond, PhD"

What is the Status of Providers Who Are In-Network at SMC LME but Out-of-Network at WHN LME?

Here is an e mail to a gentleman at SMC LME.  If anyone knows the answer to this question, please contact me at:  Thanks.  Marsha V. Hammond, PhD, Licensed Psychologist, NC

"You stated: "Hello, Dr. Hammond

Contracts between WHN and providers will be honored in the partnership agreement between SMC and WHN.  Please refer to the FAQ’s page on both the SMC and the WHN websites for updates regarding the partnership; and we are frequently posting new information as details are being worked out.

Please feel free to contact me at anytime via e-mail or at the phone number listed below.


Daniel Johnston, MSW, LCSW
Contract Performance Specialist, Northern Region
(828) 265-5315 ext. 3326"

I am an IN NETWORK provider w/ SMC LME and an OUT OF NETWORK PROVIDER w/ WHN LME.  What is therefore my status re: WHN catchment area? 

I won't go into the fact that it took a year to get even that squeezed out of WHN LME and if you wanted to see what a hassle it was to work w/ them you could look at my blog.  

All I want to know is if I can bypass them altogether.  A completely useless LME and I'm glad they've skidded off the road.  

Pass this to anyone you like.  "