The Texas Department of Insurance fined Humana $700,000 for not maintaining enough physician anesthesiologists in three counties, according to the American Society of Anesthesiologists.
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.
More articles on anesthesia:
Former pain physician sentenced to 20 years in prison after allegedly causing multiple overdoses: 5 details
6 anesthesiologists, pain physicians facing criminal charges for murder, fraud & more
The Joint Commission's new pain standards take effect in January: 5 things anesthesia groups should know