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Humana Health Insurance


Unethical Practice

Complaint Rating:  100 % with 1 votes
100% 1
Contact information:
Humana Health Insurance
United States
Your insurance coverage details are outlined in what is called your 'certificate of coverage'. Surely you can access this from Humana's website. No, it is not available on the web. I called Humana and was told they would not send it to me. Tiffany told my husband that she could look up our plan to reference our certificate, but it would take a couple of days. This was one of many calls where we were told something different each time we called.I have Humana Healthcare from the city I retired from, and I moved to a rural area. I was able to find a doctor on the plan. He is not close to a lab and has permission to send his lab work to the Hospital two miles away, to be tested in their lab. It was catagorized as lab work only. It was a blood test on blood drawn at the doctors office... $15 co-pay and $10.00 lab work. Oh, No!! I was charged an outpatient Hospital deductible of $100.00 By Humana's definition... an Outpatient is treated at the Hospital and confined for a period of less than 23 consecutive hours. When I argued that I was never physically at the Hospital, and therefore did not fit the definition...I was told that 'My Blood, which is a part of me' was there...so I had to pay as an outpatient. My husband needed a stress test and went to a Cardiac Clinic in a Larger City that was In-Network, so we figured we were safe. Wrong! One of the employees that was on the bill, was not In-Network. This place had over a hundred employees. We have Tiffany on tape saying that it is the patient's responsibility to check each and every person, at the facility, who could possibly be involved in your treatment... prior to treatment...even if there are hundreds. It doesn't say that in the certificate either. This company makes it nearly impossible for you to find out what your coverage is, and then changes the wording in the agreement to find a way to deny coverage or get a larger deductible. My husband and I have spent countless hours dealing with this company, on more ridiculous issues than I can relate here. I do have tape and documentation, though...for every claim. We are currently in the appeal process and if The City did not have a contract with Humana, I would not use them. I definitely do not recommend them to anyone and I feel sorry for the Seniors who think Humana's Medicare Plan will help them.
Complaint comments Comments (2) Complaint country United States Complaint category Health & Beauty
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 11th of Jun, 2011 by    0 Votes
sounds like you need a lesson in how insurance and what medical terminology is. i would like to disclose that i DO NOT work for humana. i do work for a competitor though. alot of bad rep is given to insurance because of not knowing. which, seems to be the case here.
the company i work for, we also cannot send out the outlines of coverage. with retiree plans or group plans, the employer would have these to send out.
the first large discrepency with your complaint is sending blood work to a hospital. you argue that its not outpatient. its a lab. Yes, it is a lab. but a hospital is an "outpatient facility". a lab would be a free standing company that would do only lab work. they would not be part of a hospital. LabCorp and Quest diagnositcs are examples of what a lab really is. if you send bloodwork to a hospital, it is going to come back as outpatient hospital.
as far as being billed for out of network...that one is always a touchy subject. it is true that its your responsibility to ensure who treats you, is in network. if you go to an outpatient facility for a stress test, your going to get a bill from the facility and from the physician. ya, you checked to make sure the facility was in network, what about any other parties that are going to submit a bill also? saying it isnt your responsibility is just trying to place blame on someone that it doesnt belong to. your a grown person, you have every ability to take care of things yourself. i hate to sound blunt, but there are alot of people that try to throw an excuse to save some face.
i know for sure that humana has a website that allows its members to view their providers and your member benefits.
insurance companies dont try to find loopholes to not pay. but, they are going to strictly follow the medical terminology and what an employer puts in its retiree or active employee benefit package. insurance companies dont make money off of how things are processed. you pay the providers for each individual service that you recieve. not the insurance. so, for these services that they arent covering for some reason, the bill isnt coming from humana. it will be coming from the doctor and the doctor wont be sending money to humana.
 5th of May, 2012 by    0 Votes
My wife needs high blood pressure medication. She has tried several types and the doctor recommends one type only, all the others cause here to faint, blood pressure drops and she goes out. Humana keeps insisting that she use the cheaper drug ( they are the ones she has problems with) but Humana will not help pay for them, and tell the pharmacy to change the prescription. We have submitted forms from the doctor as to what type she needs to take. Humana is playing doctor. Who do we call to fix this??

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