My wife had an accident 14 months ago where she broke off her good teeth from her gum studs from a serious fall. She suffered in excruciating pain for many months while we submitted numerous appeals because Humana said "dental" was not covered (all initial appeals are ruled upon by Humana paid people). Humana continuously blocked us from receiving medical attention on every point!
Finally we got to the Federal Court of Appeals. The judge ruled fully and completely in our favor, stating that if an accident caused the damage to her teeth it cannot be considered routine dental, and also that we had an Advantage Plan (Humana Gold) with expanded coverage. The judge proceeded to outline to Humana why they never should have denied us medical coverage in the first place!
Our doctor said humana always refuses coverage in an array of medical claims routinely in an effort to not pay out money for necessary medical claims. My doctor said after some people filed appeals and got turned down they gave up before making it to the Federal Courts, which he said eliminates 95% or more of the appeals! (It takes up to a year or more to make it to the Federal Courts). The Federal judge instructed Humana to pay for our medical treatment 5 months ago. So far Humana refused to arrange or pay one penny! I called the judge's clerk and asked how do I enforce the judgment? I was told they didn't know of any way to enforce said judgment! While my wife continues to suffer we will have to dig up the money to pay for a private attorney to sue in civil court!
Note: You cannot sue humana for pain and suffering, punitive damages or even attorney fees because the Government gave them immunity. So what do they have to lose by not paying?!! Humana is an example of a company that will let you die for the sake of pure greed (their stocks have reached all-time highs on the NYSE)!