State and school employees and retirees hit obstacles when seeking mental health treatment; doctor blames Humana

State government and school employees in Kentucky have trouble seeing a psychiatrist because of Humana Inc.‘s low reimbursement rates and unrealistic requests for paperwork, an op-ed piece in the Lexington Herald-Leader contends.

Humana manages the Kentucky Employee Health Plan, which has 285,000 current and retired Kentucky workers as members. But those needing mental health services are apparently running into roadblocks, Dr. Jeffrey Tuttle writes:
“Humana dictates the fee, which is often significantly lower than the regional market rate. Humana also requires in-network psychiatrists to submit medical records and documentation so they can determine if an appointment is medically necessary.” But many doctors are uneasy doing so “because it jeopardizes confidentiality and leaves major treatment decisions in the hands of any anonymous Humana employee.”
Visits to out-of-network providers arte likewise complicated, Tuttle alleges, in large part because Humana only reimburses $69 per visit, though the going rate, according to the Healthcare Bluebook, is $160. That low reimbursement means many more visits to meet the health plan’s $800 deductible.
However, visiting in-network providers can be difficult. “Of the 83 active psychiatrists with a primary office in Fayette County (excluding psychiatric residents in training), only 12 work in clinics accepting Humana plans,” Tuttle writes. “To make the situation worse, several of these psychiatrists are not accepting new Humana patients.” (Read more)
Humana did not respond to a request from Kentucky Health News for comment.
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