State and school employees and retirees hit obstacles when seeking mental health treatment; doctor blames Humana

State government and school employees in Kentucky have trouble seeing a psychiatrist because of Humana Inc.'s low reimbursement rates and unrealistic requests for paperwork, an op-ed piece in the Lexington Herald-Leader contends.

Humana manages the Kentucky Employee Health Plan, which has 285,000 current and retired Kentucky workers as members. But those needing mental health services are apparently running into roadblocks, Dr. Jeffrey Tuttle writes:

"Humana dictates the fee, which is often significantly lower than the regional market rate. Humana also requires in-network psychiatrists to submit medical records and documentation so they can determine if an appointment is medically necessary." But many doctors are uneasy doing so "because it jeopardizes confidentiality and leaves major treatment decisions in the hands of any anonymous Humana employee."

Visits to out-of-network providers arte likewise complicated, Tuttle alleges, in large part because Humana only reimburses $69 per visit, though the going rate, according to the Healthcare Bluebook, is $160. That low reimbursement means many more visits to meet the health plan's $800 deductible.

However, visiting in-network providers can be difficult. "Of the 83 active psychiatrists with a primary office in Fayette County (excluding psychiatric residents in training), only 12 work in clinics accepting Humana plans," Tuttle writes. "To make the situation worse, several of these psychiatrists are not accepting new Humana patients." (Read more)

Humana did not respond to a request from Kentucky Health News for comment.

Humana reinvents itself again, to adapt to U.S. health-care reform

Humana, Kentucky's largest corporation, says it is reinventing itself in the wake of the federal health reform law, focusing on becoming a "well-being" company rather than just a provider of health insurance.

Of the notable changes, the Louisville-based corporation that started life almost 50 years ago as a nursing-home company, then ran hospitals, is now back in the business of providing medical care directly, The Courier-Journal's Patrick Howington reports. That change is due to the $790 million purchase of Concentra, which operates occupational and urgent-care clinics (photo of Dr. J. Shawn Standridge and Danny Murphy by C-J's Michael Hayman). Humana Chairman and CEO Michael McCallister said similar purchases in fields like home health and information technology are expected.

Humana is also involved with development of products such as fitness games that can be played online and a water bottle that tells its owner when it's time to rehydrate. The company is also planning to market diabetic supplies to consumers, and is selling research to health-care companies about the effectiveness of certain drugs. "It's a significant change in our strategy," McCallister said.

Part of the change is due to the new health law, which will mean a $136 billion federal cutback in Medicare Advantage, a supplemental coverage program. Humana is the program's second-largest provider with 1.9 million members, and half its revenue comes from the program.

Though Humana laid off 750 Louisville workers early last year, analysts predict the company will weather the changes. Though Medicare Advantage cuts will likely mean there will be a predicted 5 million fewer seniors enrolled in the plan by 2019, other, smaller providers will likely stop offering it. Humana will be there to pick up those lost customers, analysts contend. (Read more)