I am a coding specialist for a Eye doctor in rural Missouri. I have had numerous people call in and complain because there is a Out of Network deductible for their services rendered by our doctors. We explain to our patients ahead of time that we are not providers but we can bill their claims out for them and everything is subject to their plan. Come to find out there aren't any In Network doctors within 65 miles.
I felt especially bad for a couple from the town I live in that we have been seeing since 1996. This patient has to have test ran every 3-6 months to monitor a condition for his eye (he only has one, and now has glaucoma in his other eye).
Anyways, I spent an hour on the phone and I found out there is a waver that the parients can fill out to get their claims processed as in network if there isn't any In network docs within 30 miles, so we did all of that and got an authorization for all backdated services and through the end of the year. Now about 2 months later and 9 calls and 4 hours + on the phone with people that can't help me I am still stuck! I have spoke with Supervisor after supervisor that promice the moon and all I get is rejections and duplicat claims.
I finally called the patients Insurance agent to inform him that the insurance that he sold these people was not something that is working for them, started to explain all the problems with In and Out of networks and he and said "People hear what they want and he has been selling this insurance for 5 years" well Mr Gary I want to let you know that this poor guy with only one eye has been coming to us for a very long time and you should ask more questions and "qualify your customers" before you sell them a useless insurance plan!!!
BEFORE YOU BUY HUMANA - CHECK TO MAKE SURE YOU HAVE DOCTORS IN YOUR AREA!!! HUMANA IS NOT THE SAME AS MEDICARE!
My complaint is against Humana and its sales associate Dennis Gabauer. My parents are paying monthly on a policy that is supposed to cover my mother's prescriptions.The above mentioned associate met with my parents in their home approximately 3 months ago. He explained to them that my mother's prescriptions would be covered and that she would not end up in the so-called "donut hole" for a long time. I am not sure if that is what happened or if this associate just lied to them just to make a sale. Maybe he was told this by Humana Inc. just so that he could lure more people in. Either way my mother's prescriptions have not been covered and they total over $500. a month. My parents are in their 70's and do not have the income to pay for her prescriptions so my mother has considered just not taking them. These medications are life sustaining. I have spoken to Mr. Gabauer and explained to him my mother's situation. He told me at that time that he remembered my parents and he also remembered telling them that my mother's medication would be covered. He told me that the company should cover them and he could not understand why they weren't. He told me he would get back to me the next day after he checked his paperwork. He did not get back to me, however, he talked to my mother the very next day and told her the same thing. He admitted to her that he remembered her situation and that he did state to her that her prescriptions would be covered. He also stated to her that he could not understand what the problem was. When I called him the day after that he returned my call to tell me that he has been told he is no longer allowed to discuss anything with myself or my mother. I do not understand what is going on. It seems that either the company itself is either trying to cover something up or just rip off elderly people. Since my parents have paid for months of coverage that they never got but were promised, I feel that they should be reimbursed the total they have paid. I also feel that since my mother has had to pay full price for her prescriptions, that the company promised would be covered but lied, she should be compensated monetarily for the amount that she had to pay due to the company's lies. I am going to contact the Office of the Inspector General of the US regarding Medicare fraud to file a claim. I will do whatever it takes to get to the bottom of this. I also will contact whoever I have to so that this will be settled in a manner I feel is appropriate for my parents.
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 that came up 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, on a personal note, 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 anymore in a year and a half, but in the mean time I have a question for 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!
I have had terrible experience with Humana Medicare Coverage. I have Humana Medicare insurance and the first...
I am a member.my name is Janet Whelpley.my ID is H59025533 I recently had cataract surgery with implants.I cannot find an eye doctor to make my glasses.I need reading glasses.Humana gives one pair of glasses a year after cataract surgery also.Can you give me a optician in Okeechobee that I can use.I have made calls to the names in the phone book.And noone takes Humana that I have phoned.Please look into this for me I dont know what to do ext.Give me a name please.
Thanks Jan Whelpley
I got a HumanaOne policy and soon after it started I was told I needed back surgery. Humana told me it was covered, and Humana told the doctor it was covered. I had the surgery. Now Humana has decided NOT to cover it. They will not say why and they will not give me anyone to talk to about it. this will cost me more than $20, 000 in hospital and doctor bills. Humana hangs up one me when I call about it. if I ask for someone in charge, they put me on hold for 30 minutes or more and then hang up on me. THESE PEOPLE ARE ### AND LIARS AND CHEATS. STAY AWAY FROM HUMANA ONE. THEY HAVE RUINED MY LIFE.
Humana has jacked me around ever since I signed up in Mar 2009. I'm constantly on the phone trying to...
Tow claims 1 for a dental check was done out of network, the policy provide for 50% reimbursement it paid for less than 40%, and I had a routine physical, covered under the policy, the doctor recommended a shingles vaccine, recommended for people over 60, Humana would not pay for. $194.
I changed jobs and Human said I would get a packet for a State of Continuation on my health coverage. I...
I'm beggin anyone who has had problems with Humana to email, call, or send a letter to me stating your...
Wife called Humana to ask questions about health insurance rates, etc. I recieved a message 2 days later from Joshua an underwriter wanting me to call him back. I called back, and after going through 3 peopole who wanted to know my policy #, I finally reached him. What about "I do not have a policy with your company" is so hard to understand. I was cut off while on hold twice as well. I finally reached Josh, the underwriter, he begin to name off Medications I was on 5 years ago and wanted to know what my exact diagnosis was to be on the medication. Well actually he told me that the medication was for depression and also for anxiety and that he needed to know which I had been diagnosed with. Well my reply was that it was to help me stay calm while dealing with people like him who pull my medical records without authorization. I checked with my wife and she had signed nothing allowing them to view my medical records. I was unaware of everything except for the fact that Josh had left me a message and I was returning his call. I then called back and asked for a supervisor and told him the situation and how I was unhappy that my medical records where pulled without me authorizing it. As well, Joshua never verified who I was other than the fact that I told him my name when I called. The supervisor told me they had every right to pull my medical records because my wife had requested rates. I told him shouldn't I have at least been notified or at least got a call to make sure my wife and I were still living together. His was response was that they are not required to do that, and even said that they would just charge my wife with insurance fraud. The part that got me the most was when the supervisor told me that they had a system that pulled up the persons information who was calling based on the phone #, so they could tell if the call was the person they said they were. So I asked him what # I was calling from. He gave me my wife's # . Funny, I was calling from my work phone with my wife 20 miles away. I guess he thought because I have a southern accent that I'm stupid enough to believe something like that from him. With all this said, I just want people to be aware that Humana basically does what they want how they want. Even after all this, the supervisor tried to convince me to buy the policy...I told him he must be out of his mind. They seem to find the path of least resistance to stay legal instead of making any kind of effort to ensure the privacy of thier customers. I will stick with Blue Cross Blue Shield.
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 categorized 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.
I had a medical procedure done late last year while covered by Humana Health in Louisville. In three phone calls to Humana, I was told my co-pay would be $25.00. However, when I received my Statement of Benefits outlining a $500.00 co-pay, I immediately made and specifically documented my third call to Humana informing me again of a $25.00 co-pay. On denying my appeal, Humana documented a false date and false information of my first call, and Humana would neither acknowledge nor deny my third call. Because Humana has maintained their stance on my calls, I have complained Humana in my case had been dishonest with me.
About six months ago, my husband's company switched from United Healthcare to Humana health insurance...
My husband and I have worked for the state of Ky. for 13 years (for me) and 14 for him. He was also a member of the Army Reserves for this entire time. He recently retired instead of rejoining for 4 more year until he is 60. When I was working we cross referenced and our payments were maybe the most expensive was 40.oo a month for both of us and our daughter and son. I never had a complaint, NEVER until just the last couple of months. We had Tri care and of course I was not out anything for surgeries, medications that were prescribed we 3.oo and no more than 22 if they werent formulary. I want to get in touch with the head executive of the comany and find out what I need to do in order to make this affordable. 400+ dollars for my husband and myself is totally unrealistic.
I went to get my effexor refilled. I have been taking this medication for 6 years. I have never had to pay anymore than 29.00 for this medication, My husband went to have his Cozaar refilled, same story, the insurance company has to decide if this is the right thing medication for the doctor to prescribe for us, so it needed to be preapproved before we could get it. Okay it was approved and it was something like 165.00 WITH the insurance. Now let's add a minute. I am paying 400+ a month. I am now paying premiums at the doctors office anywhere from 10-20 for that. I have no other insurance such a dental or optical with it, just strictly medical. My husband's blood pressure was in the stroke range, and the drug store could and would not give him enough meds to get him by to see his doc to have them changed. So I have wound up in the emergency room, I have had to see a gastronologist and he would not even treat me for the other things that need to be treated because without the Effexor, my abdominal problems would not respond well to the medication. so I have been down in the dumps. I have isolated myself from all my family and friends, they get on my nerves, and I can't stand myself so I just dont want to bring them down with me. I want the CEO headquaters comepany, I also want to bring this to thier attention. I will be mailing out several letters to senators, and other folks who think they are much more important because they do not have to worry about insurance when they are older. Just to let you in o n what has been going on since we had no medication while waiting on Humana to say it is okay to have them or not, My husband has had a blood pressure of 157/116, I cried, been to the emergency room because my stomach was cramping, so, i still thought what a waste of time I am spending in an emergency room taking up space that others with life threatning injuries may need, simply because it is easier than waiting on my physician to get into his office, so he can order me something that my 450.00 a month premium insurance is not going to pay for supporting people in Ky who have no health insurance, but I think it is unfair when we pay that kind of money, and the welfare system gets better care than we do. Prison life is good for insurance.I worked there for 13 years, I KNOW beyond a doubt if something is NON FORMULARY for the inmates, a stroke of a pen when it is presented to our Dept of Corrections Medical Director of the state who by the way is a Mental Health Doctor a bona fide Psychriaist who used to work at the Ky State Reformatory as an on staff Psych MD. I will be submitting letters to everyone that I can get through to, this is highway robbery, this is why people cannot afford insurance and go on welfare so their kids can be covered, but what happens when that parent becomes so sick he can no longer take care of his/her children, because he cannot afford the insurance for himself, or the medication for himself. I would appreciate if you could send me other addresses, so I may get this out there. I f not that is fine I will find them on my own. I know this is going to be a long drawn out process, but I can be a patient person when I beleive in something.
My son was enrolled in Medicare part A, B & D during his transplant in 2004. We received a letter at the beginning of June 2007 stating that coverage for Medicare would end the last day of June 2007. However since Humana was the Medicare Insurance for part D, they should have removed him from the part D coverage. The part D coverage is for prescriptions. Since this was all new to me when they started billing me a premium I just assumed that my son had to have Humana so that he could still get his prescriptions so I paid the monthly premium.
At the beginning of January 2009 we called in to have his scripts refilled and Medicaid would not cover the cost because they stated that he had another insurance which is Humana Medicare Part D. Medicaid told the pharmacy that they needed to run them through Humana Medicare part D and whatever costs were left the Medicaid would cover that cost. So at the last minute we had to have Medicaid to an emergency Humana Medicare override so that we could get the scripts, and keep in mind that my sons anti-rejection medications are $3500 to $5000.00 monthly. At this time my sons transplant coordinator and myself started working with Humana to have him disenrolled. I started calling Humana on January 20, 2009 as of today March 26, 2009 I think I finally got this resolved but with NO HELP from Humana. I called Humana 9 times and got 9 reference numbers and got told the same thing, 'I will send this report to the disenrollment department and they will contact you within 24-72 hours. At one point they said that I needed to write a letter that was signed and fax it to the disenrollment department so I did. I still did not hear back from anyone. I had to ask Medicaid to do 2 Medicare overrides by this time. One in February and one in March so that we could get the prescriptions paid for.
I think that Humana has got to be the worst Insurance company out there. They will continue to take your money and contact you as soon as you are late on a paying the premium, but all be damn if anyone over there will help you if you want to disenroll. How in the United States of America can we let a company do this. My husband and I are both working citizens that each of us work 40 hours a week all I have ever asked from the government is to help my son during and after his kidney transplant to cover those costs.
Over the last few months I have spents HOURS on the phone to Humana, during my work hours. We have another child that we pay for his insurance and this is how this insurance company treats us. While there is allot of people that take advantage of the system I am NOT one of them, yet they have taken advantage of us. This is a very serious matter that has happened to several citizens and it needs to be taken care of.
Do not choose humana perscription drug insurance — unfortunately I did. My premiums and copays went up by 50% just three months into my plan. (Bait and switch??) their customer service people are poorly trained at best and rude at worst. They sent me a letter denying coverage for a drug I had never heard of nor was ever perscribed for me! Tried to say I hadn't paid premiums even after they had a copy of the cancelled checks from my bank showing they had cashed them well in advance of the due date. My pharmacist just cringes when the name humana is mentioned. They are a problem all the way around.
Health insurance is on the front burner of most political conversations. I offer a honest and complete story regarding Humana's health insurance polocies. In short, I have seventeen pages docuementing phone calls, written letters, and actual bills to support my previous statements. In the worse case scenario, you lose an hour by reading about Humana's detailed fraud. At best, you are the first to break a story involving health care that will "blow everyone out of their seats." While I am 98 percent sure you will write me off as a crazy person looking for revenge, I hold onto the other two percent. I'm offering a story that is important to all persons. Please give me the option to send you my previous docuementations. (I can't spell!!). thankyou, jenny schmitz
I needed a series of three hepatitis B vaccines for nursing school. I called my prescription drug insurance...
Every time I turn around Humana decreases what they will pay for. The most frightening thing is the pain and sleep medication I have been taking all my life. They just stop covering medication that is addictive! I hope every one of those executives and the "fake helpful" service reps come down with MS, Cancer, Diabetes, and every other incurable condition and they can't find any insurance to cover thier basic needs. Let them see what it is like to be told "In 30 days you can no longer have your medication". Drop Dead Humana!! Burn in Hell!!