Here’s what you should know:
1. TDI was alerted about Humana’s low network numbers in Bexar, Harris and Travis counties by Sherif Zaafran, MD, Noah Bunker, MD, and the Texas Society of Anesthesiologists.
2. Humana terminated anesthesiologist group contracts mid-contract, which resulted in patients receiving care from out-of-network physician anesthesiologists at in-network facilities, the group reported.
3. Some Humana enrollees who were treated by out-of-network physician anesthesiologists at in-network facilities received balance bills. Humana reportedly “will hold patients harmless and their financial responsibility will not exceed in-network cost sharing requirements,” according to the ASA.
4. Texas law requires Humana to contract with enough providers to meet its obligation to provide healthcare services.
5. Humana had a sufficient number facility-based anesthesia providers in January, but by June, dozens of facilities didn’t have any in-network, facility-based anesthesiologists. The insurer allegedly didn’t report the decrease appropriately.
6. Humana is Texas’ fourth largest health insurance writer and ninth largest health maintenance organization. ASA advocates for appropriate network adequacy laws and policies to ensure fair payments in situations where a provider or service is out-of-network.
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