Response Letter to Humana- My options: violate my code of ethics, break the law, or terminate agreement.

August 31, 2015

Dear Mr. Buss,

Thank you for your response regarding my concerns over Humana’s ICD-10 conversion. Yes, I know that HIPAA requires all HIPAA covered entities convert to use of ICD-10 effective October 1, 2015. In fact, I worked with a group that was instrumental in achieving the initial delays and that worked toward another delay- until special interest groups, such as specialty hospitals and IT, lobbied and won (bought) the votes of their favorite Congressmen in DC. Imagine if all the money and resources spent on ICD-10 conversion were instead spent on actual patient care.

As I stated in prior correspondence, I will only comply with and implement policies and procedures that 1.) serve the patient first and 2.) are the best utilization of precious medical resources, including time and money. Implementation of ICD-10 does not serve the patient first and is not the best utilization of resources. If I convert to ICD-10, it will only be a stop gap measure until the next required by law mandate comes along that does not best serve the patient and is not the best utilization of resources. What will the next required by law mandate be? One can only imagine. Accordingly, I will not convert to ICD-10. Therefore, because I do not want to break the law, I am forced to not be a “HIPAA covered entity.” I guess I am a conscientious objector in some sort of strange new government-run, “war on private Hippocratic medicine” way.

I have enjoyed my relationship with Humana up until this point; however, it seems your company has done little to resist, and in fact facilitates, the complete government takeover of medicine. By now, you should have received a letter of termination from me. I caution you regarding the advisement you are planning to give my patients, your members, in this regard.

In your letter you state, “If your contracts are terminated, Humana will need to advise your patients who are Humana members that continuing with your practice once you are a non-Participating Provider will result in greater personal out of pocket expense under their benefit plan and Humana will assist those members who choose to do so, to move to another Humana Participating Provider where they will not experience the added out of pocket expense.” In fact, my new transparent fee schedule may result in many instances where the cost will be less to the patient to stay in my care than through their Humana plan which shifts them to another doctor under Humana’s fee schedule. It is a sad state of affairs that a fleeting membership with an insurance company trumps the longstanding relationship with the chosen doctor. That my patients, your members, are shuffled from doctor to doctor each year results in a serious waste of time and resources and results in worse continuity and quality of care. Do not mislead my patients of, in many cases, twenty-plus years saying that staying in my care will cost them more in every instance. Humana has clearly transformed from providing health insurance to providing prepaid medical care, including selection of the patient’s doctor. This destroys the patient-physician relationship, the foundation of Hippocratic medicine. This is not without risk to the patient, and Humana will ultimately be held accountable.

Imagine how much better it would have been for private insurance to collaborate with the doctors and patients instead of the federal government in effecting health care reform. Going forward, is there any person or part of Humana that would be willing to work with third party free medical practices to offer low cost, high deductible, major medical indemnity plans in a paradigm-shifting alternate model of health insurance? The number of physicians practicing third party free has increased from less than 1% in 2008 to 7.2% in 2014 with 13.3% transitioning to third party free practices in the future. It appears that United Healthcare will become the single-payer for the feds. Maybe Humana would be interested in forging a new path with those of us who are creating new models of health care delivery. I believe we will succeed in providing state of the art care directly to patients at a fraction of the cost. I would love to discuss this with anyone at Humana that has any interest in peeking outside the box and the beltway.


Kristin S. Held, M.D.


7 thoughts on “Response Letter to Humana- My options: violate my code of ethics, break the law, or terminate agreement.

  1. Thank all of you for your bold stands; I wish more of the general population could see what’s really going on! I also hope more and more physicians will join the third-party ranks!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s