TMA has learned Humana is terminating 422 physicians in 17 Texas counties from its Medicare Advantage Plan network, effective Jan. 1, 2016. Humana sent termination notices to physicians on July 1.
If you receive a termination letter from Humana, federal law gives you the right to appeal Humana's decision through a third-party physician review panel. You must submit your written request for an appeal within 30 calendar days of the date of the notice from Humana. The request must include any written information you wish the physician review panel to consider.
TMA's white paper outlines your rights if an insurance plan terminates you from its network. If you receive a termination letter from Humana and have questions, you can contact Humana's network relations director at (800) 626-2741.
In a letter to Genevieve Davis, director of TMA's Payment Advocacy Department, Humana indicated it is in the process of "realigning" its Medicare Advantage primary care physician network in Texas.
Humana stated its ongoing evaluation of the network includes "a review of each practice's panel size, administrative compliance and the level of participation across the provider engagement continuum." The insurer also considers "network access requirements, practice specialty needs and geographic factors. Humana actively manages and oversees its Medicare Advantage network to ensure it meets the needs of its various stakeholders including members, physicians, and plan sponsors."
Humana is terminating from its Medicare Advantage Plan network physicians practicing in the counties of Bexar (30), Collin (13), Dallas (110), Denton (38), El Paso (4), Ellis (3), Grayson (11), Harris (84), Hunt (5), Kaufman (2), McLennan (1), Nueces (3), Tarrant (65), Taylor (2), Travis (30), Williamson (12), and Wise (9).
Action, Aug. 3, 2015
Last Updated On
August 01, 2016