Business

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

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

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.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn