Humana review: Claims reimbursement issue

FORMAL COMPLAINT – UNRESOLVED CLAIMS REIMBURSEMENT DELAY OF EIGHT MONTHS

To: Humana Appeals and Grievances Department

Subject: Formal Complaint Regarding Eight-Month Delay in Claims Reimbursement

Dear Humana Appeals and Grievances Department,

I am writing to formally express my frustration and dissatisfaction with Humana’s failure to resolve my reimbursement claim for medical treatments that I paid for out of pocket and that I understood were covered under my Humana Gold Plus HMO D-SNP health insurance plan.

It has now been eight months, and despite my efforts to get this matter resolved, I have still not received the reimbursement I am owed. My provider, Pivotal Motion Acupuncture, has had much difficulty getting this claims reimbursement resolved with Tivity.

I should not be the one to suffer this financial loss that I cannot afford. I did everything I was told to do and still no help to bring this problem to resolution.

Unfortunately, there was a misunderstanding with my provider, Humana and Tivity regarding where the necessary paperwork was supposed to be submitted and how the reimbursement process was to be handled. However, I have made efforts to correct this situation and provide the necessary information. It is extremely frustrating that, after eight months, this matter remains unresolved, and it should not be my responsibility to take care of this! I can’t begin to express the frustration, disappointment and dissatisfaction with Humana and Tivity that I feel right now.

I understand that processing claims and reimbursements takes time, but an eight-month delay is unreasonable. As a paying member of Humana, I expect my claims to be handled in a timely, professional, and responsible manner.
Tivity is liable and responsible in this complaint as well. Look at my file, and you’ll see I spoke to so many people and supervisors from Humana but still no help to resolve this issue and get my necessary reimbursement. I cannot afford to pay almost $400 out of pocket and never get reimbursed!

I am requesting the following:

1. An immediate review of my outstanding reimbursement claim.
2. A clear explanation of why this matter has remained unresolved for eight months.
3. Confirmation that all required paperwork has been received and properly processed.
4. A specific timeline for when I can expect my reimbursement.
5. If there is any additional information or documentation needed, I expect to be notified promptly so this matter can finally be resolved.

Please consider this letter a formal complaint and request for immediate attention. I do not want to continue making repeated calls or resubmitting paperwork because of confusion or miscommunication within the claims process.

I have been patient throughout this process, but, as mentioned, it is wearing very thin, eight months is more than enough time to resolve a reimbursement issue. I mean no disrespect in any way, but expect Humana to take responsibility for addressing this matter and provide a prompt and satisfactory resolution.

Please respond to me at:
j.[protected]@gmail.com.

Thank you for your immediate attention to this matter.

Sincerely,

Jessica Schwennesen

Humana Member ID: H75922019

Phone Number: [protected]

Date: October 29, 2926