200 Kentucky doctors booted from Humana networks

Physicians say the insurer made its decision based on cost, not quality. But the state said the plan violated no laws.

By Emily Berry — Posted Aug. 13, 2009

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Doctors from Humana's home state of Kentucky are appealing the company's decision to remove them from the company's Medicare and commercial networks for what they believe are cost-based criteria.

According to the Greater Louisville Medical Society, about 100 physicians have been removed from Humana Medicare network over the past 12 months, and another 100 from its Select Plus HMO and Preferred networks.

Humana spokesman Tom Noland did not say how or why the company decided to terminate the Kentucky physicians from its networks. He said "extremely few" physicians had sued or appealed to the company.

Kentucky's "any willing provider" law requires insurers to disclose criteria for inclusion in networks and to notify patients if their physician is terminated from the network. It also bars insurers from excluding physicians who care for high-risk populations or who practice in areas that make them likely to have higher-than-average claims.

In December 2008, the Kentucky Dept. of Insurance reviewed complaints from two physicians who were excluded from Humana networks and concluded that the company hadn't violated any state law, spokeswoman Ronda Sloan said.

But Sarah Chasteen, manager for medical practice advocacy at the Kentucky Medical Assn., said the group is encouraging physicians who have been excluded from Humana networks to appeal the plan's decisions.

The KMA and GLMS sent letters to Humana warning it of the potential negative consequences the network changes would have on patients.

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