Sunday, August 04, 2013

How Does Humana Change from a 'Medicare Advantage' Company to a 'Private Company' w/o Advising Providers?

This is associated w/ a conversation w/ an aide in Senator Burr's office:  Cooke, Jason (Burr) <> wrote:


FROM: Marsha V. Hammond, PhD 
Clinical / Health Psychology
NC Licensed Psychologist

DATE: June 28, 2013

RE: request for policy paper from CMS as re: agreement w/ Humana that professional providers must go onto the Humana Panel

Hi Mr. Jason Cooke of Senator Burr's office: 

Thank you for speaking w/ me on the phone the other day. 

We spoke about the matter associated with some kind of contract or agreement which has obviously been created between CMS and Humana causing Humana to require professional mental health providers, such as myself, to move 'onto panel' when this was not an issue prior to 1.1.2013.  Humana did not tell providers that they had to do this.  Only after bugging NC Insur Comm office, a higher up woman stated that yes, it was her understanding also that providers had to apply to be on the panel.  I did this about a month ago. 

This is yet another barrier to health care.  As you know, Humana purports to be a 'Medicare Advantage' company which causes its insured or those considering jumping from regular Medicare to a Medicare Advantage company to believe there is no impact upon providers.  I have lost thousands of dollars re: Humana's management of its mental health services.  As I advised you, I have talked w/ a CMS representative, specifically the gentleman at this number: 410 786 1047) and have e mailed him.  The only thing he was able to do was to link BACK to Humana who, of course, had no answers.  

I want a copy of the policy paper or policy change that created the necessity of me, a PhD psychologist, long utilizing Medicare, to go onto the Humana Network.  As of this date, I have not been approved.  Humana indicated to me----after a dozen phone calls from my end----that it would 'take months' for this to take place.  So, meantime, I am paid at a lesser rate and less than what I was being paid last year.  Additionally, Humana is bothering me for a 'pay back'  as re: one of my clients as their system did not 'catch' that I continued to be paid at the same rate as last year for that client.  I advised them that as they had not advised me of the change in rates and that I therefore had no opportunity to decide whether I was going to continue to see the client or not.  I advised them  that I had no intention of paying them back. 


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