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We received Humana authorization for Home Health Aide services (G0156) for up to 24/7 of care for D. Johnson and R. Johnson – from Alyssa K., Humana Utilization Management Nurse. Alyssa affirmed via e-mail that Humana would pay for the HHA care that was authorized. For months, Humana repeatedly 'lost' the claims we faxed and mailed. And recently, we've received claim denials citing that the HHA care that we were authorized and assured payment for, is not reimbursed separately. We received $0 in payment for $112,930.95 of billed HHA care. Ms. R. Johnson's care has been paused due to non-payment from Humana.
Claimed loss: $112,930.95
Desired outcome: Reimbursement for claims
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Authorizations were received in writing with coverage confirmed as well, yet everything was denied afterwards. That is complete fraud backpedaling. Losing your faxes for months to then claiming not reimbursed separately is purely fabrication to dodge a payout in the six figure range. Should you have a confirmation cited/a statement from Alyssa, that’s your weapon. Go straight to legal whenever you want. They thought you would be silent about it. Make them pay for underestimating you.