Humana / fraud and cheating
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.
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