Humana fined for network deficiencies at 20+ hospitals, surgery centers

Humana faces a $700,000 fine from the Texas Department of Insurance due to its network adequacy, the department said Oct. 8.

Humana put consumers at risk of facing high out-of-pocket costs due to an inadequate number of in-network anesthesiologists in Texas' Harris, Bexar, and Travis counties, according to the department. A lack of in-network anesthesiologists affected patients seeking services at more than 20 hospitals and surgical centers.

In August, the department contacted Humana after learning about several cancellations of network contracts for anesthesiology services. Humana agreed to immediately correct the cancellations and reprocess bills at in-network rates after meeting with the department.

"Protecting consumers from balance bills was a priority in this case, and we've done that," Texas Insurance Commissioner Kent Sullivan said. "Humana has agreed to process these as in-network claims. Not one Humana consumer will pay extra because of this network issue."

"The matter addressed under the Texas Department of Insurance Consent Order is unique to Humana's commercial health insurance business in Texas. It does not in any way impact Medicare or other government business," Humana spokesperson Marina Renneke told Becker's in an emailed statement. "To provide assurances to our commercial insurance members and respond to concerns raised by the Texas Department of Insurance, Humana agreed to the Consent Order, as we always strive to meet state and federal regulatory standards. The Texas Department of Insurance has now certified that the Humana commercial facility-based surgical anesthesiology network is adequate."

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