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Humana Complaints & Reviews - Fraud and cheating

Humana Contacts & Informations

Humana

Posted:    Lloyd

Fraud and cheating

Complaint Rating:  93 % with 14 votes
Contact information:
Humana
United States
humana.com
About six months ago, my husband's company switched from United Healthcare to Humana health insurance. The first thing I did was go to Humana's website to make sure our family's doctors - my son's pediatrician, my OB/GYN, and our family dentist - were in Humana's network. I really liked all of our doctors, I'd done a lot of research to choose the best ones, and I did NOT want to change.

My son's pediatrician was the only one that didn't show up on the network list. I called their business office to see why they didn't take Humana. They said they used to take it, but had a very hard time collecting from them. They said Humana had a habit of automatically paying the doctor less than the agreed-upon amount for a service, and then making the doctor's office jump through hoops to get the rest of their money. They said when they did pay out, it took forever to get a check, and often required multiple claim submissions. And they said Humana refused to pay for what the doctor considered to be routine care for a child, including some vaccines and screenings, and that they nit-picked every chart in an effort to get out of paying for care. They said their relationship with Humana got to the point that it wasn't worth it anymore, so they dropped them. And as disappointed as I was, I can't say I blame them.

So I went to Humana's website and found a pediatric clinic that is in their network. I went there and I hated it. It was clearly an inferior facility and inferior quality of care compared to my previous doctor. And I was even more frustrated when, a month or so later, I got a bill in the mail for $104 from the doctor's office. Apparently Humana had paid only $34 of my son's 15-month well-child check-up. I called Humana to tell them there must have been some mistake. They said they only paid a small percentage of the claim because I went to an out-of-network doctor. I said, 'No, actually, the only reason I even know that doctor exists is because I found them on YOUR website.'

After putting me on hold for more than 10 minutes, they came back on and told me the clinic I had gone to was in-network, but the particular doctor I saw was not. I asked them how in the world I, as a consumer, am supposed to know that just because a clinic is in-network doesn't mean the individual doctors are. After much, much, much back and forth, they agreed to resubmit the claim and pay it. They acted like they were doing me the biggest favor in the universe, and kept stressing that this is a one-time ONLY exception they were making for me. Gee, thanks jerks.

Not long after that, my husband went to see our family's dentist, which was in-network. Humana paid for his entire check-up, no problem. He didn't even have to pay a co-pay. Two weeks - yes, exactly fourteen days - later, I went to the same doctor and got the same check-up and x-rays. When I finished the appointment and went to check out, the office manager informed me that I owed them $280. I informed HER that I had dental insurance - here's my card, which I've already shown you when I came in.

She said, 'Oh, I guess they didn't tell you we don't take Humana anymore.' I said, 'What are you talking about? My husband was just here two weeks ago and you took our insurance THEN.' She was very nice, but she told me they had been in contract negotiations with Humana for months and couldn't reach an agreement. The dentist had requested a small and routine increase in fees, and Humana had bluntly refused. She said the amount they were willing to pay would not even, in some instances, cover the dentist's costs. I told her I refused to pay, since they should have told me when I walked in and showed them my card that they no longer accept Humana.

I called Humana to protest and got nowhere. They said it was my responsibility to know whether the dentist was in-network. Apparently I should have checked to make sure the dentist was still in-network just before I walked out the door to go to the appointment. Checking before I MADE the appointment wasn't good enough. So now the $280 is in limbo, with me, the dentist, and Humana refusing to budge.

After the dentist incident, I thought it might be wise to go back to Humana's website and make sure every doctor in the state hadn't dropped them. I was especially worried about losing my OB/GYN. I had established a great relationship with them during my first pregnancy, and I felt comfortable with the thought of future pregnancies knowing I would be in their good hands. So when I pulled up a list of in-network OB/GYNs in my county, my stomach dropped.

Not only was my doctor not on the list anymore, but there are only three doctors in my entire county that take Humana. And I don't live out in the boondocks, I live in Raleigh! For comparison's sake, I went back to United Healthcare's website to pull up a list of their in-network OB/GYNs in my county, and got a message that I would need to narrow my search criteria because my search had returned more than 300 doctors. THREE HUNDRED. Humana offers three doctors, none of which is less than 40 minutes from my house, and only one of which delivers babies at the hospital closest to me. I called my OB/GYN's office to find out more information about why they dropped Humana and... well, by now you can guess what they said.

Last week, I woke up in the middle of the night with horrible lower abdominal cramps. I started to get worried that it was something serious, since I very rarely have any abdominal or gynecological issues. Then I thought, 'It'll be okay, because if this still hurts in the morning, I'll just call my gynecologist.' And then I remembered that, thanks to Humana, for all intents and purposes I don't have a gynecologist. Or a dentist. Or a pediatrician. Or any good alternate choices available that DO accept my insurance. It was a terrifying feeling. I guess this is what it's like to not have any health insurance at all.

So we're shopping around for a health insurance plan that we'll have to purchase out of pocket. It will cost a lot more than we pay for Humana through my husband's company, but we're willing to pay for peace of mind.
Comments United States Health & Beauty
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 28th of Jun, 2010 by   Manda22007 0 Votes
Wow something similar to your dentist visit happened to me with my eye doctors. I have this brain condition which also involves my eyes. I have been going to the same eye doctors down the street since I was a little kid. THEY are the ones that discovered my brain condition and they have all the tests, medical equipment, and prescription writing abilities to take care of it, but Humana says I can only go to them for glasses and check ups but anything involving the condition I have to go all the way into the city to the main campus for a guy to do all the same tests my local eye place did. Which never works out because I always end up late even when I leave hours (HOURS) earlier than necessary because I'm not familiar with the area and they always give my slot away and refuse to see me for another three to six months. No kidding. If this appointment is so unimportant that it can be put off for so long then why have it at all? Well anyways, it's been over a year since I had my last eye exam and I really need new glasses. So I made an appointment with the people down the street but after I gave them my credit card and the new temp gave me the receipt I realize she charge me more than they normally did. We came to the conclusion that she accidentally charged me for a special eye test that I do need, but could no longer get there because it is connected with my brain condition. She seemed to be having trouble getting the extra amount off my bill, so a full time worker came to help and as soon as she came over and saw my Humana card she said they no longer took Humana. It sparked a big debate with all the workers there weather they did or not. (It was so funny, them not knowing if they still took my insurance) Finally someone got on the phone with Humana and they figured out that if you go to any out side place of Humana (which my eye place was now considered as), the card would still work and act like it accepted Humana. However, you have to pay up to 3, 000 dollars each year first, then after you have paid that full amount Humana would pitch in a fraction of any costs after that. So the lady that called Humana explained to me that the bill I initially got would have just gone toward the 3, 000 dollars and I would have gotten a bill for the rest later. I almost let the bill go at first thinking that it had been a long time since I had that special test done and should really get it, luckily I anticipated that that might cause me problems through Humana and decided against it. I had no idea what problems I would really be stopping! And its good to know that thing about places accepting the card even if they don't actually accept Humana. Now I'm paranoid every where I go though. Also, after I had finished catching up with all the lady's that work at my eye place, and turned to go, I nearly wanted to cry. I had been going there since I was a little kid...now I had no reason to go back...

I did find out that because of a recent change in the insurance I wont be eligible for it in a year, but in the mean time I have a question for you Lloyd, or anyone that reads this. Where is the list of places that do take Humana because I've looked and looked but I can't find it!? Any help would be much appreciated!
 30th of Jun, 2010 by   qscott86 0 Votes
Your account is riddled with half-truths and no-truths.

You, as a member, are always responsible for verifying a provider's network status regardless of what is was 2 weeks ago or an hour ago... plan changes happen all the time. The here-say you heard from a doctor's office about their dealings with Humana are just that - here-say. And no, dentists are the real greedy ones here.. they make more than enough to cover their costs and they don't ask for small increases.. they ask for outlandish ones.. so Humana was probably wise to not renew their contract with your dishonest dentist.
 8th of Jul, 2010 by   Lizzclayborn 0 Votes
I am having the same OUT OF NETWORK problem with Humanna. Have only had their PPO since 03/10. I verified that our Doctor and his office are in network. Now, even though most of the customer service people that I talk to assure me that my Doctors office is indeed in network and say they will resubmit the claim and get it paid...nothing happens. Some of them are down right rude and tell me that my Drs office is billing wrong or that it is up to me to file a dispute. If the customer service people can't figure out whether or not some one is in network...how the heck do they expect me to know??? I'm stuck with them until Nov. then I'm switching to another company. People warned me and I should have listened but they were so nice when they wanted my business.
 21st of Jul, 2010 by   Lizzclayborn 0 Votes
Physician Finder Plus - MyHumana

Other Providers:
Physician Details
Perry County Family Practice Inc

Network: HumanaChoicePPO (Medicare PPO)

1625 Airport Rd
New Lexington, OH 43764

County: Perry
Phone: (740) 342-5158
Fax: (740) 342-7393


This is my Drs office...how can they say it's out of network???
 25th of Mar, 2011 by   JerryinGlbrt 0 Votes
In Dec 2010, my daughter needed her wisdom teeth extracted. Our family dentist referred us to a Dr. Fish, a specialist in Chandler, AZ. Upon entering the office, the receptionist asked for my insurance card. I handed it to her, and asked that their office pre-determine my out of pocket costs for the services. She said I could talk to the person that handles their insurance claims. After the Dr. finished the initial examination, I also mentioned to him that I would like to know what my out of pocket responsibility would be. He said that would be available from the insurance person. Finally, I was sitting at the desk of the insurance/financial person, and again requested to have a predertermination of my out of pocket costs. She said they don't offer that service, but they would invoice my insurance company and everything would be all right. Two months later, I started to receive billings for the total amount of the work. I called the office and was told that they were "out of network", and that I was now responsible for all charges. I told them that I had asked 3 times during the initial visit to predetermine my costs, and was refused. About one week later, I called the office and without telling them who I was, asked if they accepted SecureCare Dental insurance. The receptionist immediately responded "NO". I am convinced that the insurance person knew all along that we would not be covered, but didn't want to turn away our business! I told them that I would be willing to pay exactly what I would have been responsible for had they been in-network, but they refused to budge. I would expect to experience unethical treatment from a used car lot, but not from a dentists office!
 29th of Jan, 2013 by   Terrorism in Healtcare A Reality 0 Votes
"Well" is unfortunately a 4 letter word at Humana. It appears to be a problem within, which of course, affects their services. In their training, they teach "perfect service" - however, the caliber of nurses and staff is "terrorist-like", and if an employee shows signs of applying "perfect service", the employee experiences horror stories, and may be threatened with sharp cutting objects. It is common for a Humana employee to appear to brag that they may be the next "terrorist".

I was not able to use Humana's insurance. Although I paid for it to start at the beginning of the month, it was not ready, so I could not receive the medical services that I required. Many Humana members are in the same boat. The insurance applications are not processed on a timely basis, so even though you have paid for the insurance, you cannot use it. If Humana took the time to steer their employees away from terrorism, then they would have more time to process the applications promptly. The health care industry is in the hands of nurses and other staff who behave like terrorists - Humana is probably the worse example of such decay.

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