GLMS INSURANCE UPDATES HUMANA
Vasu Kakarlapudi, MD
D
id you know that GLMS meets with
five insurance payers quarterly to discuss updates from the payers and
hassles that have been reported by GLMS
members? Below are the main points from
our Quarter Two Humana meeting.
• Senate Bill 18 - Senate Bill 18 requires
insurers to follow a new and fairer set of procedures before changing an existing agreement with a provider. This
law goes into effect January 1, 2017, and contracts written after July
1, 2016, must adhere to these changes. The role of GLMS will be to
communicate and provide education to members on the provisions
of Senate Bill 18. Specifically, SB 18 requires:
- ninety (90) days’ notice for a material change;
- notices for material changes dealing with membership networks
or new/modified insurance products to be sent by certified mail
- notices for all other material changes to be sent in an orange-colored envelope;
- notices that describe the material changes;
- an opportunity for providers to use “real-time communication”
to discuss the proposed changes with the insurer;
- a clean, consolidated informational copy of the agreement after
three (3) material changes in a twelve (12) month period; and
- an opportunity for providers to object to proposed material
32
LOUISVILLE MEDICINE
changes by utilizing specifically defined procedures.
• Humana Provider Simplification Process - Humana is rolling
out a process to keep practices from having to contact multiple representatives based on the reason for their call. Noting that having
various people assigned to different roles can be counterproductive,
Humana created the Provider Simplification Process. Providers will
be assigned one “go-to” provider representative within Humana
to help them resolve issues, answer questions, or assist them in
whichever way they need. The assigned person will be empowered
to make decisions affecting the provider and resolve their concerns.
This process is slated to begin in the Kentucky market in September.
• Use of Out-of-Network Labs – Humana has identified an
increase in utilization of out-of-network labs, specifically for broad
panel drug testing. Use of out-of-network labs may result in higher
costs to the patient.
• Value Based Contracting – Continued discussion on value
based contracting and pay for performance. Humana has expressed
interest in learning new ways to incentivize physicians for improving
patient care, patient experience and cost of care.
Look for more information in the coming months as the GLMS
Insurance Issues Resolution Committee continues to work to resolve
the most pressing issues you face each day.
Vasu Kakarlapudi, MD, is an otolaryngologist with Advanced ENT
& Allergy and Chair of the IIRC Humana Committee.