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Humana / claim denial

Apache Junction, AZ, United States

I have been dealing with Humana regarding a bill I incurred in July 2016. I fell broke my leg (ankle) while visiting in Minnesota. Humana denied the claim because of referral...out of network services. I was not aware of the denial-a result of no paper!! I was made aware that I had a bill at Summit Orthopedics in May 2017. They had been sending bills to an address that I had not lived at for 3 yrs. I started back tracking collecting paperwork to get this bill paid by Humana. After several phone calls with clinics and Humana I was advised that I needed a referral from my primary care physician in Arizona where I live. On July 14, 2017 my Dr’s officed faxed the information to Humana. Approx. 2 - 3 weeks later I called Humana to see if they had received the paperwork. I was then told that Humana would not pay the bill because of the time frame involved. In the meantime I have been referred to a collection agency. I then called Humana and was told to file an appeal. I was transferred to another department which turned out to be a recording. In frustration I turned to my insurance agent who made phone calls. In a 3 way conversation it was decided that I needed to have the referral from my Primary care resent. That was sent on Oct. 2, 2017. I called yesterday to see what was happening and after being on the phone and on hold for 1 hr. I was rolled to another customer service rep. I hung up assuming the original rep. would return my call. That did not happen. I called again today and was told they had not received my referral...that’s twice!! Once maybe, twice, absolutely not!! I had to call my Dr’s office again and this time request they call the referral in. I am angry, frustrated and embarrassed that I need to keep making demands from a dr’s office that had absolutle no involment in services rendered.

Km
Oct 13, 2017

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