Texas Fines Humana $700K for Network Inadequacy

October 12, 2018

The Texas Department of Insurance has fined Humana $700,000 for putting consumers at risk of paying higher bills because of an inadequate number of anesthesiologists in Harris, Bexar and Travis counties. The problem meant consumers couldn’t get in-network anesthesia services at more than 20 hospitals and surgical centers in three of the state’s largest metro areas.

TDI said inadequate provider networks put consumers at risk of receiving balance bills for the difference between what a doctor charged and a health plan paid. Consumers getting services from in-network providers are protected from balance bills, and their copays and coinsurance amounts are based on the health plan’s contracted rate with the doctor.

TDI first contacted Humana in August after learning several of its network contracts for anesthesiology services had been canceled. After meeting with the agency, the health plan agreed to immediate corrective actions and to reprocess bills so consumers didn’t face higher costs due to inadequate networks.

Insurance Commissioner Kent Sullivan signed consent orders outlining all the corrective actions and the fines.

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

Health plans operating in Texas must file annual network adequacy reports with TDI and must notify the agency and consumers of any gaps in the network. Humana submitted reports to TDI that included providers no longer in its networks and did not adequately or timely disclose the issue to the agency or consumers.

“Texas has strict network adequacy standards, and we’re going to hold insurers accountable for meeting them,” Sullivan said.

Humana is the fourth largest health insurance writer and ninth largest HMO in the state.

Source: TDI

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