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Price Fixing



Kansas City, KS: (Mar-19-08) A class action lawsuit was brought against Humana Inc. and other insurers, alleging that the companies engaged in a conspiracy to suppress payments to physicians. Blue Cross and Blue Shield of Kansas City, United Healthcare and Coventry Health Care of Kansas Inc. were also named as defendants in the class action suit filed in 2005. The suit alleged that the business practices of the health insurers violated antitrust laws by fixing prices and engaging in other monopolistic behavior, such as refusing to negotiate reasonable reimbursements.

Sources stated that a settlement has been reached in the case, in which Humana agreed to pay the doctors $2.8 million in cash. The agreement is said to affect 2,200 doctors, who are eligible to participate in the settlement. Legal sources claimed that the doctors will split the money based on billings to Humana over a three-year period. Additionally, the company also agreed to process and pay physician bills in an accurate and timely manner. The company said it does not admit any wrongdoing in agreeing to settle, but has done so in order to avoid the costs and risks of litigation. [THE KANSAS CITY STAR: HUMANA AGREES TO SETTLEMENT WITH AREA DOCTORS]


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Reader Comments

Posted by

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It scares me to read such a sad story. I heard humana was a fair comany. Really sad
Indeed.

Posted by

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patients were most probably made to pay the extra cost of the doctors shortfall and before a settlement is made they should be informed as i am sure they suffered due to the higher amount on their bills.

Posted by

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I worked for AT&T for many years. There was a blurring of lines when it came to Humana and AT&T so much so that i was directed to ask humana policy questions by management and upper management of which Humana could not answer because they cannot comment of AT&T's policy. I ended up having to take AT&T to mediation and the lawyer representing AT&T was so confused by the blurred lines that he asked the Humana representative AT&T policy questions which she answered knowing she isnt allowed to and caused me to lose everything. What can I do?

Posted by

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I have Spasmodic Torticollis; a rare Neurological Disorder characterized by sustained spasms which contort the position of my head.in a fixed position.. Contrary to my prognosis, which allowed for the continuation of a productive life, I have been consumed by regularly denied essential care and medications throughout the past 18 years! The consequences have become life-threatening. My chin has been pulled down to my chest, which constricts my airway, and limits my diet to mush. The Disorder, initially localized within my neck muscles, has progressed down my spine, and my vertebrae are now abutting my spinal cord. Repetitive Appeals have sabotaged the care I should have been able to receive. The pain associated with Torticollis accounts for a 20% suicide rate. Chronic stress from denied care and medications have added to the very visible consequences, and caused Post Traumatic Stress Disorder. I have been covered by numerous insurance companies, some with gate-keepers blocking the Appeals Process. My current coverage with HUMANA began in January, and for the past 3 months, a medication has been denied. Cutting-edge testing has eliminated the presence of other causes. I have since developed Kyphosis and Spinal Stenosis. Based upon the atypical severity of my Disorder, I have been video-taped as a case study by NY Presbyterian Neurological Institute; published in Neurologic Periodicals; and have been "poster child" for a nation-wide organization. At present, a prescription has been reviewed by HUMANA for an entire month, and is still being denied. My life has been taken from me AVOIDABLY, and I have suffered beyond words. WHERE ARE MY 37 years of FICA taxes? How can this exist in AMERICA? Through extensive research and networking, I have learned of cases f a pre-mature demise. NJ and NY mis-use Federal Funds, depriving the disabled of the essentials of living. NY Policy denies my Durable Medical Equipment. Drug control is focused on the disabled, while addicts do business on the streets. I AM A VERY ANGRY CITIZEN, and do not believe the extent of unenforced ADA, Constitutional, and Civil Rights Laws should be an executive privilege. Government-contracted insurance companies, or the OMB should determine a right to essential medical care.

Posted by

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Humana is crap. I am just now finding out. They do not have a thing to do with the mediare medicade card period. Which is not told to you when signing out. False advertisement. How are they still able to do business, Sounds like a lot of fraud going around with the governments help.

Posted by

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I am interested in bringing a suit as primary plaintiff against an Insurance company with a pattern of improper prior authorization activity on cms patients. I will explain when we speak. I have the papertrail..

Posted by

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My work declined after getting Humana through Marketplace. It was two months in and along with my caregiver job I also would start work with my plant vending job when weather got warm. Things started to decline. Didn't send papers m.p. wanted so my premium went up understandably. From 46 dollars to 346 dollars. I paid the first month then canceled on the following month on the 1st. I was told I would have to wsit 2 wks. for it to process. Not right but fine. I psid thd two weeks and decided to follow up with care with my doctors.
HERE IS THE PROBLEM Humana changed my policy without me knowing. It was the same policy except I was paying 300 more a month. I asked if it would. I was told no. It shouldn't just bc I no longer receive the tax credit. What does that have to do with the policy I contracted under? I paid my total out of pocket snd deductible. Everything was to be covered by a 100 percent. Come to find out they changed it to where my deductible and out of pocket wsd a large amount. I wss paing under contract pos silver. Which was 750 deductible and 500 out of pocket limit. It changed to 3300+ and 7600+ out of pocket going back a month. Then after cancelling this is what is hspoening. I have a feb. Card that states the 750/500 and a May card that states it. Now I just received another card AFTER cancelation that I have not opened. I cancelled July 1st. They cancelled it on the 16th THEN I get a new card that I have not opened bc I know it will say July with a changed amount. I thought it eas against the law to change my policy unless I changed it. Please help. Medical bills will come because they changed my plan without me knowing to where it changed my out of pocket and deductible just bc my tsx credit went away shouldn't change my plan I wsd paying for full priced.

Posted by

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dec 30th 2015 i had a colonoscopy and found out that i have a colon cancer tumor in my lower colon. the doc doing the test told me i would need surgery very soon, he ordered a cat scan and referred me to a surgeon that would take my humana medicare advantage plan, i am under 65 and am on ss disability and it is the only plan i can get to cover me for the 20% the medicare dont pay . before my app, to see the surgeon , we were informed that the place he would do my surgery did not take humana. first.delay , i am then referred to a new surgeon before he can schedule surgery they need me to have a pet scan to rule out some things that were found in the cat scan , after a week the night be i was to go in we are called by my surgeons office and told humana will not ok the pet scan this is now a on going negotiation furthering my delays , as my condition gets worse and more advanced. I have seen the complaints about humana and im scared to death i will not get modern timely care i am going to need to survive this disease. We do not have the resources for legal help but we will do what we have to. This just seem so wrong to have this to deal with now , i am lucky my wife works in human resources and is good at helping me with this i get so angry when i talk to humana on the phone i can not get anywhere

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