Humana setting new standards for the health insurance industry

On yesterday’s front page of The Wall Street Journal, Bedside Manner: An Insurer Tries A New Strategy – Listen to Patients, it describes in great detail about Humana’s strategy to provide better information to patients, especially given the growth of consumerism in healthcare. I have always been impressed with Humana’s tools and information available to its members on its website. However, I wanted to convey a personal story showing that while the tools are great, they weren’t sufficient to keep me as a member due to other operational issues. At the same time, I recognize that Humana is leading a trend and continues to raise the standard that other insurers have begun to follow.

About six months ago, I switched my health insurance from Humana to Blue Cross Blue Shield of Massachusetts. After several years as a Humana member, I shuddered every time my family needed to go to the doctor because I knew that there would be challenges with how the claims would be processed… ranging from outright errors, the limited breadth of their provider network, and ambiguous definitions of how ancillaries and diagnostics are handled. I would have to study every claim, call their claims center, make detailed notes, and then follow up with multiple subsequent calls to ensure that the claim was processed properly. It was also very confusing, even to someone who works within the healthcare field and has an above average knowledge of healthcare billing processes and idiosyncracies.

On the other hand, I was always quite impressed with Humana’s member website and online tools. MyHumana includes a secure personal home page where a member can consolidate information, set preferences and drive all health benefit transactions through one location. In addition, they have web-based tools to project pharmacy costs and make a pharmacy benefit plan decision based on a member’s budgetary and medical needs.

In contrast to Humana, Blue Cross Blue Shield of MA has a wide panel of providers in Massachusetts, and there have been no challenges with claims processing. There have been some recent upgrades to their site – Treatment Cost Calculator (run by BCBS Association), Hospital Quality Comparison Tool (powered by HealthShare and includes many evaluation metrics from Leapfrog and CMS Hospital Quality Initiative), as well as syndicated content from WebMD. While I consider them to be “behind” Humana with respect to information tools such as online claims history, pharmacy history, and pharmacy cost calculators, I have seen improvements in this area.

WSJ does point out that Humana “has beaten rivals to the market with some innovations” and that many of these innovations can be easily copied. Some of Humana’s newest innovations include: a quarterly personalized health and financial statement (available online and by mail) as well as expanding into “other types of health services, including long-term management of chronic conditions such as diabetes. It recently formed a joint venture with Swiss medical-device company Card Guard AG to design cellphone-based weight-loss and diabetes-monitoring programs.”

I hope that Humana’s market research and innovation efforts continue to drive the whole industry to a new standard of better consumer-driven information tools.

April 12, 2006

2 thoughts on “Humana setting new standards for the health insurance industry”

  1. I signed up with Humana in July ’09. Have 3 Rx that need to be refilled but Walgreens will NOT accept Humana. RightSource, owned by Humana, will NOT transfer Rx from Walgreens so another Dr. visit to get new Rxs.

    Now the point — how can anyone believe Humana deserves all the above ‘glowing’ statements about being a helath care leader with innovative tools, etc. when Humana refuses to transfer a VALID Rx ????????????

    Surely Humana needs to go back to the very basics of customer service.

  2. I pay 200 a month for humana health insurance and i have 700 in medical bills humana refuses to pay with no reason why.I think i am going to drop my health insurance so I can pay my medical bills.

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