Sunday, July 05, 2015

About the Aetna and Humana merger

Barry Grey (WSWS) reports:

Aetna Inc. and Humana Inc., the third and fourth largest US health insurance companies by revenue, announced Friday they had reached a deal for what would be, if approved by the government and carried through, the biggest ever merger in the industry. Industry analysts consider it likely that federal regulators will allow the takeover, slated to take effect next year, to proceed.
Under the agreement, valued at $37 billion, Aetna will assume control over Humana, creating the nation’s second largest health insurer after industry-leading United HealthGroup Inc. Aetna Chief Executive Officer Mark Bertolini will become chairman and CEO of the combined company.

It's a powerful and important article, raising many issues.

One that's not raised is jobs.


This is important because Humana has outsourced to a Laos call center for calls from providers.

There are American 'clinical teams' that the Laos call center can transfer to -- if they feel the need or desire.

But what we've heard from doctors, nurses and office managers are tales of Laos employees who do not understand the basics of Humana's plans.

For example, a doctor in Brooklyn explained to us that Humana Gold HMO, unlike Humana Medicare PPO, requires that the doctor obtain a referral if he or she wants to send the patient to a specialist for a consultation.  If you try to pursue that online, the referral tends to pend (pointed out by many, not just the Brooklyn doctor).

If you try to pursue it on the phone?

You will be told, as the doctor was, "This plan doesn't require a referral."

To which the doctor insisted, "Yes, it does, it's Humana HMO."

No, he was told, it was Humana PPO.

No, he replied, "I am looking at a scan of the card and it is Humana HMO.  Can I please speak to someone in America?"

He had to ask five times before he was told he was being transferred.

Instead of being transferred, he was hung up on.

An African-American (we include race for a reason) office manager in San Diego shared the same story but when she asked to speak to someone in America, she was told she was "discriminating.  You are racist."

"I didn't even dignify it with a response," she told us, "I just kept asking to speak to an American.  Seven requests later, I was transferred to Lisa in Louisiana who was able to see it was Humana HMO and get me a referral immediately."

Aetna thus far has used US call centers.

Will the merger change that?

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