Guest guest Posted September 3, 2009 Report Share Posted September 3, 2009 I get paid quickly and well by Humana. The only annoying/concerning thing is that for the Humana medicare patients (of which I have 3), I have been asked for their complete chart on each one of them! For no apparent reason! Kris I have had minimal problems with them. They had my address confused for awhile, but fixed that, and i get paid promptly. They have few hassles and paid 25's. From: [ ] On Behalf Of Ellen son [nellegreenearthlink (DOT) net]Sent: Thursday, September 03, 2009 1:18 PMTo: Subject: Re: Scoop on Humana They just sent me a contract too in Portland---wondering the same.Ellenjenlynwallace wrote:> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2009 Report Share Posted September 3, 2009 They just sent me a contract too in Portland---wondering the same. Ellen jenlynwallace wrote: > > > Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc? > > Thanks! > Jen Wallace > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2009 Report Share Posted September 3, 2009 I have had minial problems with them. They had my address confused for awhile, but fixed that, and i get paid promptly. They have few hassles and paid 25's. From: [ ] On Behalf Of Ellen son [nellegreen@...] Sent: Thursday, September 03, 2009 1:18 PM To: Subject: Re: Scoop on Humana They just sent me a contract too in Portland---wondering the same. Ellen jenlynwallace wrote: > > > Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc? > > Thanks! > Jen Wallace > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 I have about 5 Humana Medicare and also have had requests for 4/5 of their notes from visits in the past year- I think they say they are auditing correct diagnosis coding- something like that. Carla Gibson FNP To: Sent: Thursday, September 3, 2009 3:08:05 PMSubject: Re: Scoop on Humana I get paid quickly and well by Humana. The only annoying/concerning thing is that for the Humana medicare patients (of which I have 3), I have been asked for their complete chart on each one of them! For no apparent reason! Kris In a message dated 9/3/2009 4:02:35 P.M. Eastern Daylight Time, jim.kennedy@ ucdenver. edu writes: I have had minimal problems with them. They had my address confused for awhile, but fixed that, and i get paid promptly. They have few hassles and paid 25's. From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovemen t1yahoogroups (DOT) com] On Behalf Of Ellen son [nellegreen@ earthlink. net]Sent: Thursday, September 03, 2009 1:18 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Scoop on Humana They just sent me a contract too in Portland---wonderin g the same.Ellenjenlynwallace wrote:> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 After getting all your records on these patients they cream through them for excess complexity and will try to dun medicare for more money to cover them. One of our listserve had to send 7000 pages of records over a year to these sleazy groups, with the resulting unpaid time and effort, and unpaid costs; all so they could collect a little extra money from the government, none of which is passed on to the doctor. We in the IMP movement do in depth work on our patients and are gold mines for complexity. I have not signed with Humana: their advantage plan has to pay me anyway, and I am not interested in signing up with groups which change their rules in midstream to my and my patient's disadvantage. Joanne, in Drain, Oregon.> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 Just ask for the copy charges like any other insurance request. > >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 Alot of times, you are required to release without a fee............ Re: Scoop on Humana Just ask for the copy charges like any other insurance request. > >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 that's exactly why I refuse to accept Humana The Robbins Health Alliance 1324 Rockbridge Road, SW Stone Mountain, GA 30087 PH: Fax: www.robbinshealth.com Your first choice for Internal and Holistic Medicine.> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 I did not contract with Humana- I simply saw Humana Gold Choice patients... If you see the patient, then you are agreeing to the terms they offer. This is from a Humana Brochure and similar to what I remember reading from one of their letters a couple of years ago:What is a participating provider?A participating provider is a physician or other healthcare provider who knows of a member's enrollment in aHumana MA PFFS plan and has been given a reasonableopportunity to obtain the terms and conditions forpayment for services provided to a Humana MA PFFSplan enrollee. Physicians and other health care providersmust be licensed and must be eligible to provide careto Medicare-eligible patients, with no sanctions againsttheir licensure. If a physician or health care providerrenders care to a Humana MA PFFS plan member,the physician or health care provider is consideredparticipating for that member. For a copy of our fullterms and conditions, please call ProviderRelations at 1-.Does the physician have a responsibilityto somehow notify the plan that he or sheis participating?No. There are no contracts to sign, and there is nopaperwork required to participate. The physician orother health care provider simply needs to see themember's ID card to identify the individual as a HumanaMA PFFS plan member. The physician or other healthcare provider should review the terms and conditions ofpayment. If the provider renders care to the member,that provider is participating. A physician or otherhealth care provider may choose to provide care toHumana MA PFFS plan enrollees on a patient-by-patientbasis and may stop treating enrollees at any time.Carla Gibson FNPMissoula, MTTo: Sent: Thursday, September 3, 2009 9:35:41 PMSubject: Re: Scoop on Humana that's exactly why I refuse to accept Humana The Robbins Health Alliance 1324 Rockbridge Road, SW Stone Mountain, GA 30087 PH: Fax: www.robbinshealth. com Your first choice for Internal and Holistic Medicine.> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 This is crazy. According to Humana's web site, "A provider is considered by law to be deemed to have a contract with Humana" just because a provider "has a copy of, or has reasonable access to, our terms and conditions of payment". A legal and binding contract whose terms you are bound by because you could have read it, regardless of whether or not you really did?"Deemed contracting" is like the scam with the unsolicited check in the mail for $10 which if you endorse and deposit in your bank account will automatically start charging your credit card $150 a year for life until you cancel it because it says in fine print that your signature authorizes it. Yet another reason I am glad I am opted out of Medicare. SetoSouth Pasadena, CAI did not contract with Humana- I simply saw Humana Gold Choice patients... If you see the patient, then you are agreeing to the terms they offer. This is from a Humana Brochure and similar to what I remember reading from one of their letters a couple of years ago:What is a participating provider?A participating provider is a physician or other healthcare provider who knows of a member's enrollment in aHumana MA PFFS plan and has been given a reasonableopportunity to obtain the terms and conditions forpayment for services provided to a Humana MA PFFSplan enrollee. Physicians and other health care providersmust be licensed and must be eligible to provide careto Medicare-eligible patients, with no sanctions againsttheir licensure. If a physician or health care providerrenders care to a Humana MA PFFS plan member,the physician or health care provider is consideredparticipating for that member. For a copy of our fullterms and conditions, please call ProviderRelations at 1-.Does the physician have a responsibilityto somehow notify the plan that he or sheis participating?No. There are no contracts to sign, and there is nopaperwork required to participate. The physician orother health care provider simply needs to see themember's ID card to identify the individual as a HumanaMA PFFS plan member. The physician or other healthcare provider should review the terms and conditions ofpayment. If the provider renders care to the member,that provider is participating. A physician or otherhealth care provider may choose to provide care toHumana MA PFFS plan enrollees on a patient-by-patientbasis and may stop treating enrollees at any time.Carla Gibson FNPMissoula, MTFrom: Robbins Health Alliance <robbinshealth>To: Sent: Thursday, September 3, 2009 9:35:41 PMSubject: Re: Scoop on Humana that's exactly why I refuse to accept Humana The Robbins Health Alliance 1324 Rockbridge Road, SW Stone Mountain, GA 30087 PH: Fax: www.robbinshealth. comYour first choice for Internal and Holistic Medicine.> >> Humana has just moved to town and has sent me a contract. I > cherry-pick my insurance companies and generally only contract with > those that treat physicians well, meaning reasonable reimbursement > along with minimal hassles. Does anyone know how Humana is with > respect to promptness of payment, refusing to pay for technicalities, > requiring chart notes and documentation, requiring lots of pre-auths > and paperwork for drugs/studies, etc?>> Thanks!> Jen Wallace>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 Apparently many, if not all , of the Medicare Advantage carriers do this: http://www.mgma.com/policy/default.aspx?id=18732 Can this be enforced if the physician has opted out of Medicare? R. Pierce MD Rockport, Maine www.midcoastmedicine.com Carla Gibson wrote: > > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago: > > What is a participating provider? > A participating provider is a physician or other health > care provider who knows of a member's enrollment in a > Humana MA PFFS plan and has been given a reasonable > opportunity to obtain the terms and conditions for > payment for services provided to a Humana MA PFFS > plan enrollee. Physicians and other health care providers > must be licensed and must be eligible to provide care > to Medicare-eligible patients, with no sanctions against > their licensure. If a physician or health care provider > renders care to a Humana MA PFFS plan member, > the physician or health care provider is considered > participating for that member. For a copy of our full > terms and conditions, please call Provider > Relations at 1-. > Does the physician have a responsibility > to somehow notify the plan that he or she > is participating? > No. There are no contracts to sign, and there is no > paperwork required to participate. The physician or > other health care provider simply needs to see the > member's ID card to identify the individual as a Humana > MA PFFS plan member. The physician or other health > care provider should review the terms and conditions of > payment. If the provider renders care to the member, > that provider is participating. A physician or other > health care provider may choose to provide care to > Humana MA PFFS plan enrollees on a patient-by-patient > basis and may stop treating enrollees at any time. > > Carla Gibson FNP > Missoula, MT > > ------------------------------------------------------------------------ > *From:* Robbins Health Alliance > *To:* > *Sent:* Thursday, September 3, 2009 9:35:41 PM > *Subject:* Re: Scoop on Humana > > > > that's exactly why I refuse to accept Humana > > The Robbins Health Alliance > 1324 Rockbridge Road, SW > Stone Mountain, GA 30087 > PH: > Fax: > www.robbinshealth. com <http://www.robbinshealth.com> > Your first choice for Internal and Holistic Medicine. > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only > contract with > > those that treat physicians well, meaning reasonable > reimbursement > > along with minimal hassles. Does anyone know how Humana > is with > > respect to promptness of payment, refusing to pay for > technicalities, > > requiring chart notes and documentation, requiring lots > of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > ------------------------------------------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 Yikes. Let me get this straight. 'Knowledge' of a patient's third party payer, constitutes a contract. ???? Really?The criteria for a legal contract are not met. This is not a contract. It is conscription, people. We are owned. Stop the madness. Say no. Apparently many, if not all , of the Medicare Advantage carriers do this: http://www.mgma.com/policy/default.aspx?id=18732 Can this be enforced if the physician has opted out of Medicare? R. Pierce MD Rockport, Maine www.midcoastmedicine.com Carla Gibson wrote: > > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago: > > What is a participating provider? > A participating provider is a physician or other health > care provider who knows of a member's enrollment in a > Humana MA PFFS plan and has been given a reasonable > opportunity to obtain the terms and conditions for > payment for services provided to a Humana MA PFFS > plan enrollee. Physicians and other health care providers > must be licensed and must be eligible to provide care > to Medicare-eligible patients, with no sanctions against > their licensure. If a physician or health care provider > renders care to a Humana MA PFFS plan member, > the physician or health care provider is considered > participating for that member. For a copy of our full > terms and conditions, please call Provider > Relations at 1-. > Does the physician have a responsibility > to somehow notify the plan that he or she > is participating? > No. There are no contracts to sign, and there is no > paperwork required to participate. The physician or > other health care provider simply needs to see the > member's ID card to identify the individual as a Humana > MA PFFS plan member. The physician or other health > care provider should review the terms and conditions of > payment. If the provider renders care to the member, > that provider is participating. A physician or other > health care provider may choose to provide care to > Humana MA PFFS plan enrollees on a patient-by-patient > basis and may stop treating enrollees at any time. > > Carla Gibson FNP > Missoula, MT > > ---------------------------------------------------------- > *From:* Robbins Health Alliance <robbinshealth> > *To:* > *Sent:* Thursday, September 3, 2009 9:35:41 PM > *Subject:* Re: Scoop on Humana > > > > that's exactly why I refuse to accept Humana > > The Robbins Health Alliance > 1324 Rockbridge Road, SW > Stone Mountain, GA 30087 > PH: > Fax: > www.robbinshealth. com <http://www.robbinshealth.com> > Your first choice for Internal and Holistic Medicine. > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only > contract with > > those that treat physicians well, meaning reasonable > reimbursement > > along with minimal hassles. Does anyone know how Humana > is with > > respect to promptness of payment, refusing to pay for > technicalities, > > requiring chart notes and documentation, requiring lots > of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > ---------------------------------------------------------- > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 No, it only applies to providers who have not opted out of Medicare:http://www.humana.com/providers/plans/medicare/pdf/M0006_GH14201a_PFFS_KC1208.pdf SetoSouth Pasadena, CAApparently many, if not all , of the Medicare Advantage carriers do this:http://www.mgma.com/policy/default.aspx?id=18732Can this be enforced if the physician has opted out of Medicare? R. Pierce MDRockport, Mainewww.midcoastmedicine.comCarla Gibson wrote:> > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago:>> What is a participating provider?> A participating provider is a physician or other health> care provider who knows of a member's enrollment in a> Humana MA PFFS plan and has been given a reasonable> opportunity to obtain the terms and conditions for> payment for services provided to a Humana MA PFFS> plan enrollee. Physicians and other health care providers> must be licensed and must be eligible to provide care> to Medicare-eligible patients, with no sanctions against> their licensure. If a physician or health care provider> renders care to a Humana MA PFFS plan member,> the physician or health care provider is considered> participating for that member. For a copy of our full> terms and conditions, please call Provider> Relations at 1-.> Does the physician have a responsibility> to somehow notify the plan that he or she> is participating?> No. There are no contracts to sign, and there is no> paperwork required to participate. The physician or> other health care provider simply needs to see the> member's ID card to identify the individual as a Humana> MA PFFS plan member. The physician or other health> care provider should review the terms and conditions of> payment. If the provider renders care to the member,> that provider is participating. A physician or other> health care provider may choose to provide care to> Humana MA PFFS plan enrollees on a patient-by-patient> basis and may stop treating enrollees at any time.>> Carla Gibson FNP> Missoula, MT>> ----------------------------------------------------------> *From:* Robbins Health Alliance <robbinshealth>> *To:* > *Sent:* Thursday, September 3, 2009 9:35:41 PM> *Subject:* Re: Scoop on Humana>> >> that's exactly why I refuse to accept Humana>> The Robbins Health Alliance> 1324 Rockbridge Road, SW> Stone Mountain, GA 30087> PH: > Fax: > www.robbinshealth. com <http://www.robbinshealth.com>> Your first choice for Internal and Holistic Medicine.>>> > >> >> > Humana has just moved to town and has sent me a contract. I> > cherry-pick my insurance companies and generally only> contract with> > those that treat physicians well, meaning reasonable> reimbursement> > along with minimal hassles. Does anyone know how Humana> is with> > respect to promptness of payment, refusing to pay for> technicalities,> > requiring chart notes and documentation, requiring lots> of pre-auths> > and paperwork for drugs/studies, etc?> >> > Thanks!> > Jen Wallace> >> >>>> ---------------------------------------------------------->>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 I received a contract so I don't know what you are talking about. No provider should be seeing a pt on a panel s/he has no contract with. That's a given-- the pt will have to pay the bill. Carla Gibson wrote: > > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago: > > What is a participating provider? > A participating provider is a physician or other health > care provider who knows of a member's enrollment in a > Humana MA PFFS plan and has been given a reasonable > opportunity to obtain the terms and conditions for > payment for services provided to a Humana MA PFFS > plan enrollee. Physicians and other health care providers > must be licensed and must be eligible to provide care > to Medicare-eligible patients, with no sanctions against > their licensure. If a physician or health care provider > renders care to a Humana MA PFFS plan member, > the physician or health care provider is considered > participating for that member. For a copy of our full > terms and conditions, please call Provider > Relations at 1-. > Does the physician have a responsibility > to somehow notify the plan that he or she > is participating? > No. There are no contracts to sign, and there is no > paperwork required to participate. The physician or > other health care provider simply needs to see the > member's ID card to identify the individual as a Humana > MA PFFS plan member. The physician or other health > care provider should review the terms and conditions of > payment. If the provider renders care to the member, > that provider is participating. A physician or other > health care provider may choose to provide care to > Humana MA PFFS plan enrollees on a patient-by-patient > basis and may stop treating enrollees at any time. > > Carla Gibson FNP > Missoula, MT > > ------------------------------------------------------------------------ > *From:* Robbins Health Alliance > *To:* > *Sent:* Thursday, September 3, 2009 9:35:41 PM > *Subject:* Re: Scoop on Humana > > > > that's exactly why I refuse to accept Humana > > The Robbins Health Alliance > 1324 Rockbridge Road, SW > Stone Mountain, GA 30087 > PH: > Fax: > www.robbinshealth. com <http://www.robbinshealth.com> > Your first choice for Internal and Holistic Medicine. > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only > contract with > > those that treat physicians well, meaning reasonable > reimbursement > > along with minimal hassles. Does anyone know how Humana > is with > > respect to promptness of payment, refusing to pay for > technicalities, > > requiring chart notes and documentation, requiring lots > of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > ------------------------------------------------------------------------ > > > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 I have not opted out of Medicare but I am not taking any new Medicare pts. And there has been no problem so I'm not sure what everyone is talking about here. I have also not had any requests for chart notes in 7 yrs except for the occasional pt whose plan is looking for a preexisting condition and they have been very, very few.] Sounds like a coding issue and I do my own coding. Or maybe it's regional. Ellen Seto wrote: > > > No, it only applies to providers who have not opted out of Medicare: > > http://www.humana.com/providers/plans/medicare/pdf/M0006_GH14201a_PFFS_KC1208.pd\ f > <http://www.humana.com/providers/plans/medicare/pdf/M0006_GH14201a_PFFS_KC1208.p\ df> > > Seto > South Pasadena, CA > > > >> Apparently many, if not all , of the Medicare Advantage carriers do this: >> >> http://www.mgma.com/policy/default.aspx?id=18732 >> <http://www.mgma.com/policy/default.aspx?id=18732> >> >> Can this be enforced if the physician has opted out of Medicare? >> >> R. Pierce MD >> Rockport, Maine >> >> www.midcoastmedicine.com >> >> Carla Gibson wrote: >> > >> > I did not contract with Humana- I simply saw Humana Gold Choice >> > patients... If you see the patient, then you are agreeing to the terms >> > they offer. This is from a Humana Brochure and similar to what I >> > remember reading from one of their letters a couple of years ago: >> > >> > What is a participating provider? >> > A participating provider is a physician or other health >> > care provider who knows of a member's enrollment in a >> > Humana MA PFFS plan and has been given a reasonable >> > opportunity to obtain the terms and conditions for >> > payment for services provided to a Humana MA PFFS >> > plan enrollee. Physicians and other health care providers >> > must be licensed and must be eligible to provide care >> > to Medicare-eligible patients, with no sanctions against >> > their licensure. If a physician or health care provider >> > renders care to a Humana MA PFFS plan member, >> > the physician or health care provider is considered >> > participating for that member. For a copy of our full >> > terms and conditions, please call Provider >> > Relations at 1-. >> > Does the physician have a responsibility >> > to somehow notify the plan that he or she >> > is participating? >> > No. There are no contracts to sign, and there is no >> > paperwork required to participate. The physician or >> > other health care provider simply needs to see the >> > member's ID card to identify the individual as a Humana >> > MA PFFS plan member. The physician or other health >> > care provider should review the terms and conditions of >> > payment. If the provider renders care to the member, >> > that provider is participating. A physician or other >> > health care provider may choose to provide care to >> > Humana MA PFFS plan enrollees on a patient-by-patient >> > basis and may stop treating enrollees at any time. >> > >> > Carla Gibson FNP >> > Missoula, MT >> > >> > ---------------------------------------------------------- >> > *From:* Robbins Health Alliance <robbinshealth@... >> <mailto:robbinshealth%40yahoo.com>> >> > *To:* >> <mailto:%40yahoogroups.com> >> > *Sent:* Thursday, September 3, 2009 9:35:41 PM >> > *Subject:* Re: Scoop on Humana >> > >> > >> > >> > that's exactly why I refuse to accept Humana >> > >> > The Robbins Health Alliance >> > 1324 Rockbridge Road, SW >> > Stone Mountain, GA 30087 >> > PH: >> > Fax: >> > www.robbinshealth. com <http://www.robbinshealth.com >> <http://www.robbinshealth.com>> >> > Your first choice for Internal and Holistic Medicine. >> > >> > >> > >> > > >> > > >> > > Humana has just moved to town and has sent me a contract. I >> > > cherry-pick my insurance companies and generally only >> > contract with >> > > those that treat physicians well, meaning reasonable >> > reimbursement >> > > along with minimal hassles. Does anyone know how Humana >> > is with >> > > respect to promptness of payment, refusing to pay for >> > technicalities, >> > > requiring chart notes and documentation, requiring lots >> > of pre-auths >> > > and paperwork for drugs/studies, etc? >> > > >> > > Thanks! >> > > Jen Wallace >> > > >> > > >> > >> > >> > ---------------------------------------------------------- >> > >> > >> > >> > >> > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2009 Report Share Posted September 4, 2009 Ellen, I was not clear- my post was in regard to Humana's Medicare Advantage plan... I'm sure it does not apply to their non-Medicare plans. To: Sent: Friday, September 4, 2009 8:56:36 AMSubject: Re: Scoop on Humana I received a contract so I don't know what you are talking about. No provider should be seeing a pt on a panel s/he has no contract with. That's a given-- the pt will have to pay the bill. Carla Gibson wrote: > > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago: > > What is a participating provider? > A participating provider is a physician or other health > care provider who knows of a member's enrollment in a > Humana MA PFFS plan and has been given a reasonable > opportunity to obtain the terms and conditions for > payment for services provided to a Humana MA PFFS > plan enrollee. Physicians and other health care providers > must be licensed and must be eligible to provide care > to Medicare-eligible patients, with no sanctions against > their licensure. If a physician or health care provider > renders care to a Humana MA PFFS plan member, > the physician or health care provider is considered > participating for that member. For a copy of our full > terms and conditions, please call Provider > Relations at 1-. > Does the physician have a responsibility > to somehow notify the plan that he or she > is participating? > No. There are no contracts to sign, and there is no > paperwork required to participate. The physician or > other health care provider simply needs to see the > member's ID card to identify the individual as a Humana > MA PFFS plan member. The physician or other health > care provider should review the terms and conditions of > payment. If the provider renders care to the member, > that provider is participating. A physician or other > health care provider may choose to provide care to > Humana MA PFFS plan enrollees on a patient-by-patient > basis and may stop treating enrollees at any time. > > Carla Gibson FNP > Missoula, MT > > ------------ --------- --------- --------- --------- --------- - > *From:* Robbins Health Alliance <robbinshealth@ yahoo.com> > *To:* Practiceimprovement 1yahoogroups (DOT) com > *Sent:* Thursday, September 3, 2009 9:35:41 PM > *Subject:* Re: [Practiceimprovemen t1] Scoop on Humana > > > > that's exactly why I refuse to accept Humana > > The Robbins Health Alliance > 1324 Rockbridge Road, SW > Stone Mountain, GA 30087 > PH: > Fax: > www.robbinshealth. com <http://www.robbinsh ealth.com> > Your first choice for Internal and Holistic Medicine. > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only > contract with > > those that treat physicians well, meaning reasonable > reimbursement > > along with minimal hassles. Does anyone know how Humana > is with > > respect to promptness of payment, refusing to pay for > technicalities, > > requiring chart notes and documentation, requiring lots > of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > ------------ --------- --------- --------- --------- --------- - > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2009 Report Share Posted September 5, 2009 ‘No provider should be seeing a pt on a panel s/he has no contract with. That's a given--the pt will have to pay the bill.’ But Ellen, this is taken out of context, but this is how a direct practice works (the patient pays the provider of the service directly) Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com .._,___ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2009 Report Share Posted September 5, 2009 if you only have a handful of patients and the loss of the contract would not be crushing, just tell them you won't send it without their paying. i've never had them pay me, they always just say they don't want them. sometimes they pay someone to drive from philly to cape may (1.75 hours) to come and look at the chart. whatever. i've heard others say they threaten to drop their contract, which doesn't affect me, but if you've only got 4-5 patients to lose it will save you hours of work. and who knows, maybe the patients will stay and pay you cash, and you'll be on your way to freedom!! -- In , " Dr Levin " wrote: > > Alot of times, you are required to release without a fee............ > Re: Scoop on Humana > > > Just ask for the copy charges like any other insurance request. > > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only contract with > > those that treat physicians well, meaning reasonable reimbursement > > along with minimal hassles. Does anyone know how Humana is with > > respect to promptness of payment, refusing to pay for technicalities, > > requiring chart notes and documentation, requiring lots of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2009 Report Share Posted September 5, 2009 --- I understand this but then I don't understand what the issue is if the provider has no concern about being paid by insurance. The discussion was about Humana contracts and getting paid. Perhaps I missed something. Ellen Eads wrote: > > ‘No provider should be seeing a pt on a panel s/he has no contract with. > That's a given--the pt will have to pay the bill.’ > > But Ellen, this is taken out of context, but this is how a direct > practice works (the patient pays the provider of the service directly) > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, Colorado > > www.PinnacleFamilyMedicine.com > > ._,___ > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2009 Report Share Posted September 5, 2009 Last two years they have paid for the records when I ask. kevin> > > >> > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only contract with > > those that treat physicians well, meaning reasonable reimbursement > > along with minimal hassles. Does anyone know how Humana is with > > respect to promptness of payment, refusing to pay for technicalities, > > requiring chart notes and documentation, requiring lots of pre-auths > > and paperwork for drugs/studies, etc?> >> > Thanks!> > Jen Wallace> >> > > > > > ------------ --------- --------- --------- --------- --------- -> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2009 Report Share Posted September 5, 2009 We have just recieved the same contract. I turned it down. In Washington you do not have to contract with Humana if the patient is Humana/Medicare. You just have to contract with Medicare. We will accept those with Humana/Medicare just so we don't have to worry about contracting with them. If we run into problems we just stop taking their patients. Michele To: Sent: Saturday, September 5, 2009 12:21:24 PMSubject: Re: Scoop on Humana if you only have a handful of patients and the loss of the contract would not be crushing, just tell them you won't send it without their paying.i've never had them pay me, they always just say they don't want them. sometimes they pay someone to drive from philly to cape may (1.75 hours) to come and look at the chart. whatever.i've heard others say they threaten to drop their contract, which doesn't affect me, but if you've only got 4-5 patients to lose it will save you hours of work. and who knows, maybe the patients will stay and pay you cash, and you'll be on your way to freedom!!-- In Practiceimprovement 1yahoogroups (DOT) com, "Dr Levin" <dr_levin@.. .> wrote:>> Alot of times, you are required to release without a fee......... ...> Re: [Practiceimprovemen t1] Scoop on Humana> > > Just ask for the copy charges like any other insurance request.> > > > > > > >> > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only contract with > > those that treat physicians well, meaning reasonable reimbursement > > along with minimal hassles. Does anyone know how Humana is with > > respect to promptness of payment, refusing to pay for technicalities, > > requiring chart notes and documentation, requiring lots of pre-auths > > and paperwork for drugs/studies, etc?> >> > Thanks!> > Jen Wallace> >> > > > > > ------------ --------- --------- --------- --------- --------- -> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2009 Report Share Posted September 6, 2009 I simply send their fax back with a note saying they are welcome to send a representative to my office to review the charts they desire but I am not spending my money for my employee time or copying resources. I have never had Humana send anyone. I have had Anthem send someone. But then if they come, I do not allow them to "mess around" in my EMR. While there in the office they can request specific info, my staff will copy it to paper and they pay before leaving with it. Re: Scoop on Humana> > > Just ask for the copy charges like any other insurance request.> > > > > > > >> > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only contract with > > those that treat physicians well, meaning reasonable reimbursement > > along with minimal hassles. Does anyone know how Humana is with > > respect to promptness of payment, refusing to pay for technicalities, > > requiring chart notes and documentation, requiring lots of pre-auths > > and paperwork for drugs/studies, etc?> >> > Thanks!> > Jen Wallace> >> > > > > > ----------------------------------------------------------> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2009 Report Share Posted September 6, 2009 Nothing like this is in the contract I recently received. I doubt whether anything stated as below could be legal. Why would insurance or any of us bother with any contracts if this were true? If you are not on an insurance panel, then your care should be out of network for that pt. I have a few pts who see me out of network and they have to pay more out of pocket. I have nothing pro/con to say about Humana as I have no experience with them but what you have written is not as a " direct quote " and you also say it was from a couple of years ago. I think we ought to be careful what we put out to everyone as fact. Ellen Carla Gibson wrote: > > I did not contract with Humana- I simply saw Humana Gold Choice > patients... If you see the patient, then you are agreeing to the terms > they offer. This is from a Humana Brochure and similar to what I > remember reading from one of their letters a couple of years ago: > > What is a participating provider? > A participating provider is a physician or other health > care provider who knows of a member's enrollment in a > Humana MA PFFS plan and has been given a reasonable > opportunity to obtain the terms and conditions for > payment for services provided to a Humana MA PFFS > plan enrollee. Physicians and other health care providers > must be licensed and must be eligible to provide care > to Medicare-eligible patients, with no sanctions against > their licensure. If a physician or health care provider > renders care to a Humana MA PFFS plan member, > the physician or health care provider is considered > participating for that member. For a copy of our full > terms and conditions, please call Provider > Relations at 1-. > Does the physician have a responsibility > to somehow notify the plan that he or she > is participating? > No. There are no contracts to sign, and there is no > paperwork required to participate. The physician or > other health care provider simply needs to see the > member's ID card to identify the individual as a Humana > MA PFFS plan member. The physician or other health > care provider should review the terms and conditions of > payment. If the provider renders care to the member, > that provider is participating. A physician or other > health care provider may choose to provide care to > Humana MA PFFS plan enrollees on a patient-by-patient > basis and may stop treating enrollees at any time. > > Carla Gibson FNP > Missoula, MT > > ------------------------------------------------------------------------ > *From:* Robbins Health Alliance > *To:* > *Sent:* Thursday, September 3, 2009 9:35:41 PM > *Subject:* Re: Scoop on Humana > > > > that's exactly why I refuse to accept Humana > > The Robbins Health Alliance > 1324 Rockbridge Road, SW > Stone Mountain, GA 30087 > PH: > Fax: > www.robbinshealth. com <http://www.robbinshealth.com> > Your first choice for Internal and Holistic Medicine. > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > cherry-pick my insurance companies and generally only > contract with > > those that treat physicians well, meaning reasonable > reimbursement > > along with minimal hassles. Does anyone know how Humana > is with > > respect to promptness of payment, refusing to pay for > technicalities, > > requiring chart notes and documentation, requiring lots > of pre-auths > > and paperwork for drugs/studies, etc? > > > > Thanks! > > Jen Wallace > > > > > > > ------------------------------------------------------------------------ > > > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2009 Report Share Posted September 6, 2009 --- If you are not billing insurance at all, then isn't it then the pt's responsibility to deal with the bill? Why would you have any contact with Humana or any insurance company? Are you saying they are asking you for charts notes? If the pt is paying you directly and understands that her insurance may not pay, then that would seem to be the end of it. Am I not understanding something? Please let me know. Ellen Eads wrote: > > ‘No provider should be seeing a pt on a panel s/he has no contract with. > That's a given--the pt will have to pay the bill.’ > > But Ellen, this is taken out of context, but this is how a direct > practice works (the patient pays the provider of the service directly) > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, Colorado > > www.PinnacleFamilyMedicine.com > > ._,___ > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2009 Report Share Posted September 6, 2009 In Portland, taking Medicare does not mean you have to accept anyone with Medicare. Specialists who take Medicare but who have not contracted with Medicare/Care Oregon, for instance, won't take those pts. I know because I have had trouble finding specialists for them. I take Medicare but my biller has told me I have more than enough so I am not taking any more new Medicare pts. I know I can also contract with certain insurances and not accept the Medicare portion. There are many variations, at least in Oregon. Ellen Michele Ortiz wrote: > > We have just recieved the same contract. I turned it down. > In Washington you do not have to contract with Humana if > the patient is Humana/Medicare. You just have to contract > with Medicare. We will accept those with Humana/Medicare > just so we don't have to worry about contracting with them. > If we run into problems we just stop taking their patients. > Michele > > ------------------------------------------------------------------------ > *From:* bootscrowley > *To:* > *Sent:* Saturday, September 5, 2009 12:21:24 PM > *Subject:* Re: Scoop on Humana > > > > if you only have a handful of patients and the loss of the contract > would not be crushing, just tell them you won't send it without their > paying. > i've never had them pay me, they always just say they don't want them. > sometimes they pay someone to drive from philly to cape may (1.75 > hours) to come and look at the chart. whatever. > i've heard others say they threaten to drop their contract, which > doesn't affect me, but if you've only got 4-5 patients to lose it will > save you hours of work. and who knows, maybe the patients will stay > and pay you cash, and you'll be on your way to freedom!! > > -- In Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com>, " Dr Levin " > <dr_levin@.. .> wrote: > > > > Alot of times, you are required to release without a fee......... ... > > Re: [Practiceimprovemen t1] Scoop on Humana > > > > > > Just ask for the copy charges like any other insurance request. > > > > > > > > > > > > > > > > > Humana has just moved to town and has sent me a contract. I > > > cherry-pick my insurance companies and generally only contract with > > > those that treat physicians well, meaning reasonable reimbursement > > > along with minimal hassles. Does anyone know how Humana is with > > > respect to promptness of payment, refusing to pay for technicalities, > > > requiring chart notes and documentation, requiring lots of pre-auths > > > and paperwork for drugs/studies, etc? > > > > > > Thanks! > > > Jen Wallace > > > > > > > > > > > > > > ------------ --------- --------- --------- --------- --------- - > > > > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
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