MONETT, MISSOURI -- My wife had an accident 14 months ago where she broke off her good teeth from her gum studs from a serious fall. She suffered in excruciating pain for many months while we submitted numerous appeals because Humana said "dental" was not covered (all initial appeals are ruled upon by Humana paid people). Humana continuously blocked us from receiving medical attention on every point!
Finally we got to the Federal Court of Appeals. The judge ruled fully and completely in our favor, stating that if an accident caused the damage to her teeth it cannot be considered routine dental, and also that we had an Advantage Plan (Humana Gold) with expanded coverage. The judge proceeded to outline to Humana why they never should have denied us medical coverage in the first place!
Our doctor said Humana always refuses coverage in an array of medical claims routinely in an effort to not pay out money for necessary medical claims. My doctor said after some people filed appeals and got turned down they gave up before making it to the Federal Courts, which he said eliminates 95% or more of the appeals! (It takes up to a year or more to make it to the Federal Courts).
The Federal judge instructed Humana to pay for our medical treatment 5 months ago. So far Humana refused to arrange or pay one penny. I called the judge's clerk and asked how do I enforce the judgment? I was told they didn't know of any way to enforce said judgment. While my wife continues to suffer we will have to dig up the money to pay for a private attorney to sue in civil court.
Note: You cannot sue Humana for pain and suffering, punitive damages or even attorney fees because the Government gave them immunity. So what do they have to lose by not paying?! Humana is an example of a company that will let you die for the sake of pure greed (their stocks have reached all-time highs on the NYSE)!
MEDFORD, OREGON -- I spent several days going over my prescription list with a representative to insure Humana had all the information they needed to price my first Medicare approved Prescription Drugs or Part D insurance plan. I accepted the plan and terms and it went into effect January 1, 2012.
The first time I went to the pharmacy to pick up my medicine for Parkinson's disease, the prescription was filled for 24 days when it should have been for 30 days. The pharmacist told me it was Humana's decision to restrict their coverage to 8 pills per day and not the 10 pills per day as prescribed by my doctor. I went around and around with Humana and finally a representative told me she put an override order on the restriction and assured me the problem was fixed.
Next month the same thing happened. I asked about the override placed the previous month and was told it was a one time only override. The representative I was talking to told me to take the prescribed amount and come back for a ten day supply to carry me into the third month and everything would be resolved by then. It was not. In fact Humana informed me they were no longer covering the medicine in my plan - we are talking about the number one medicine prescribed to Parkinson's disease patients. I gave a copy of the letter to my neurologist and he managed to convince Humana to reverse their decision.
I also have diabetes and early in the year, my doctor gave me a prescription for insulin prefilled cartridges or "Pen injection system". I could not afford even my copay so I asked for an alternative lower cost system and was prescribed for the same medicine in viles that would load into syringe needle for my injections. My copay for this system was a third of the cost of the pen system.
Last month a new prescription was written by a different doctor who mistakenly wrote it for the pen injection. The amount Humana quoted the pharmacy was much lower than the previous quote. My wife was picking up the prescription. She was unaware of the mistake. I was out of insulin and used the pen system since my wife paid for it.
Now we are in the eleventh month of the plan and I have just entered the gap coverage or "doughnut hole" and now I pay full price for all of my medicine. The prescription cost in the pen system for one month is more than $275.00. I called my doctor and asked to have my prescription modified to the vile and syringe method. The pharmacist told me the injection method was changed but the price remained the same.
I called Humana and this time had two reps and a supervisor involved. They reminded me I was in the donut hole and expected to pay the full amount which by the way was over five hundred for a month. I asked why was the price quoted 275.00? From that point on all they were focusing on was why their own company quoted a discounted price and told me the only price they had on my insulin was the vile and syringe system. Well this is open enrollment time and as of January 1, 2013, I will have a new plan in place. I only hope I can make it that far without my medicine. No change, not resolved. :(
IDAHO -- Major "Bossy" issues and multiple minor issues: Humana sent a mailing telling me I should sign up for Humana Medicare Rewards program, then receive 4 preventive services and they would send me two rewards cards!!! What??? I'm not interested in signing up for anything and they should not be asking me to. I pay for Medicare MedAdvantage health insurance for insurance coverage, not to be part of a whole "bossy manipulation" of my life. I never agreed to let them persistently invade my privacy in whatever ways they deem necessary.
Their continual pressure to call them, to "sign up" for something, to do something for them is annoying beyond words. We all know by now that trendy "rewards programs" are never, ever free -- we always end up paying something for them. In this case, the insurance premiums are expensive in relation to their limited pool of medical providers (which is shrinking), and covered services and prescriptions are limited and continually changed. This insurances truly sucks the big one and I dropped it during open enrollment this month. I regret that I ever signed up with them.
Another annoying issue is I have received so many "robo-calls" (the phone rings but only a recording is there) asking me to call back if I can capture the multiple digit calling code before the call is disconnected. I only found out who was calling when I redialed the caller ID number on my telephone. Forget the long code -- I missed all but the first 3 numbers and they only said it once. Dumb!
When I called back, I was told several times that they were replying to a call from me -- that was a lie. The calls were coming in so often, I had to block the telephone numbers so they would not ring through because obviously they did not take me seriously when I told them to stop calling me. Oh, and I won't go into the surly customer service representative right after I signed up.
One service they have repeatedly pushed on me over the last couple of months is a home health assessment visit by a nurse practitioner employed by one of their "affiliates." I am healthy, fully independent, and highly mobile and will not allow such an intrusion into my home and my personal privacy. I have firmly said no multiple times per sales call but they persist. The last time I was quite blunt and used frank language to get them to "hear" me.
One week after my last refusal, here comes a high pressure, full-page letter from Mr. Painter, Chief Medical Officer, Health Guidance Organization, pushing the service on me (with all evidence that he probably sold used cars at some point) and telling me an appointment specialist will call me to schedule an appointment or I can call them to schedule it. What??? What part of "n-o", no, do they not understand?
Humana is not making good use of the monies paid by Medicare to provide health insurance and there is obviously a corporate mentality that they have the right to invade privacy to push their own agendas. Only buy insurance from this company if you want an "elder sitter" to tell you what you need, when you need it, how much you can have, and if you don't mind intrusive, unsolicited telephone calls and letters from them to push their own gimmicky agendas. Even my primary care physician's practice is fed up with them and they have opted not to renew their contract with Humana.
During open enrollment, I canceled this joke of insurance and switched back to a reputable insurance company who at one time provided the employer's group health insurance where I worked. They have decades of experience in the field and respect individual privacy. They do not waste money on foolishness like Humana does. I won't even talk about all of the mail Humana buried me with. Pure wastefulness.
SPRING HILL, FLORIDA -- I turned 65 in Apr 2014 and made the mistake of signing up for the Humana Advantage Plan. For the past few months I have been treated by one of their PCP. He diagnosed the pain in my hip as arthritis. I keep telling the PCP that the pain was excruciating and that I could not put any weight on it. When I went for my appointments they would come outside to the vehicle and bring me into the office in a wheelchair. His answer to my pain was "We will up the Meds". Was taking Hydrocodone 10-325 for the pain. The pills did nothing for me as the pain persisted.
I finally had enough of the pain and called the nurse at Humana. After explaining my situation she told me to get to an Emergency Room within the next 4 hours. (The only intelligent person I talked to at Humana). After having blood work, x-rays, and scans done at the ER, they recommended I see an Orthopedic Surgeon with 2-3 days. They didn't tell me what was wrong other than I needed surgery to correct my problem. I called my PCP as soon as I got home. Was told that they would have to get records from ER before they could do anything. Left message to have PCP call me.
A week and 1/2 went by, no call from PCP. I called PCP and he stated he didn't have any records from my visit to the ER. I looked up the surgeon that the ER recommended and called him. He is in the network but needed a referral from PCP. Called PCP and they refused to refer me to surgeon. They would only refer me to a surgeon of their choosing, another doctor in their group.
Now the problem, do you really think I would want a doctor in this group of doctors to perform major surgery on me? They misdiagnosed my problem as arthritis when in reality the top of my femur bone was collapsing, thus the severe pain. For 2 months I endured this horrific pain and now I have to have a total hip replacement… a major surgery. I do not trust any of these doctors in this so called group.
I called Humana and was told I have to do want the PCP says even though my surgeon is in the network. The office girl at my surgeons office got the records from the ER and called Humana arguing that they were in the network why couldn't they see me. Humana would not allow it.
When I signed up for Humana back in March I was told that I could go to any doctor I wanted as long as they were in the network. I was never told about PCP's with their own group of doctors. So I am unable to walk. Can only sit or lay down. I do have a walker and a scooter (which I paid for out of my own pocket $1200) so I can get around my house as I live alone.
Instead of getting this operation done and over with before Christmas I now have to suffer and wait until January when my new Insurance and PCP go into effect. And yes my new PCP will refer me to my surgeon. As far as Humana is concerned they lied to me when I signed up with them and their PCP should be kicked to the curb. Stay away from HUMANA!!!
SAN ANTONIO, TEXAS -- My mother was recently involved in a auto accident and taken to a ICU trauma in San Antonio. After 12 days in ICU her drs. recommended a LTAC facility. Humana Gold Plus "reviewed" the Drs. recommendations and disagreed with their request. She was moved to another floor to wait until her chest tubes can come out before Humana will let us know what they will pay for. My mother is in a 3 person room with chest tube, broken hip, open wound, 6 broken ribs, heart problems, broken femur and instead of getting the help that a LTAC would be able to provide, she is stuck waiting, against the Drs. advice, for Humana to see how she progresses.
I, her daughter, live 200 miles away had to return to work after 12 days (she is stable, just not getting well enough to stand or get tubes out). I offered to pay for transportation to Houston, where I live so that I could be there daily to assist in her recovery and help with decisions. Humana refuses to move her even though the Drs. say it would be best for her to get the care a LTAC offers and to be with family. Humana is keeping her there and making all decisions as to what care she is receiving based on what they will pay for.
My mother pays a good amount to Humana as a replacement for her Medicare thinking that she would receive the best of care. Humana has taken away her right to participate in the decisions of her health care. I would encourage anyone with parents that have Humana Gold Plus to examine other options.
Even the Drs. and hospital staff have told me that their hands are tied and they hate to see people come in with Humana because they know they can not give them the level of care that they need. Medicare is a much better option. Do not let your parents be in the position that my mother is in. Helpless and at the mercy of a review panel deciding what is best for her. Sad daughter 3/9/12 12:02PM.
I am not offered insurance with my employer and am in desperate need of dental services. I found a plan through them that gave a list of services I could receive at a discount rate and it was in my budget so I signed up. I had to pay a $35 application fee and a monthly premium of $15.10. They had a large list of providers in my area and I was very thankful to finally have great coverage.
Then the terror begins. A bunch of the providers on their list had disconnected phones and were no longer in business. Some said they never signed up as a provider for the plan, and others were so terrible I did not stay for the appointment. It would have been cleaner at the health department.
I had not utilized coverage so I called to find out what to do to cancel the policy. I was told I had to email to cancel and that was the only way, so I did. Next, I get an email back stating they received my request and it would be processed within 7 days. I wait and still nothing in my account so I call back and am told they never received my email. Not only did they not rectify the problem immediately I was told that the application fee was not refundable. They then made me email them the original email I sent and the confirmation email they sent me! So again, I did.
A week later they tell me they are processing it that day and that it would appear in my account within three days. I waited another week and called them back. They told me I had to wait longer and that it is an issue with my bank. I had to tell the lady to "stop patronizing me and open up your ears to listen. There is obviously a problem somewhere. You are customer care so HELP ME!" She told me she would look into it and call me back.
At the end of today, she returns the call only to tell me that they did cancel the account and processed that, but for some reason it had not been placed back to my card. She assures me that it would be refunded today. Yah! I told her I would talk to her again next week when they again drop the ball. Enter into a policy with them at your own risk!
DAYTONA BEACH, FLORIDA -- I have had the most alarming experience with HumanaOne. For years I have been paying premiums and not really using the insurance except for once a year doc visits and prescriptions. Then I had some dental trouble and consulted with a representative about whether I would be able to get a procedure. She told me how much money there was available and it was enough. I got the procedure -- probably totaling about $1,300 to Humana (I paid that much in co-pays since dentistry is about 50%). That unleashed a chain of events that is only getting worse.
First Humana refused to pay the claims saying I'd been "terminated." So my dentist is all upset. But I'd consistently paid my bills to Humana, and Humana was paying for monthly prescriptions well after I'd supposedly been terminated. They must have conveniently, retroactively terminated me somehow, but then apparently reinstated me right after the procedure, since I'm now current with them.
THEN, here's where it gets really bad -- Humana reached into my bank account and attempted to take out $1,900, an amount they have yet to explain. This caused an overdraft -- at first I thought it was some sort of online fraud. I was very alarmed and assured by the representative it was a grievous error. Then I was told by another representative that I owed Humana this money. Which of course makes no sense.
They still haven't told me why they felt compelled to do this. I distrust this company so much that I am considering changing my bank info lest they try it again. They were not authorized to go into my account, period. It was all very terrifying. I am quitting them as soon as I resolve the dental mess. What if I became ill with cancer? I think I know what would happen. Getting any treatment out of this company would require a legal battle for which few have the resources (because if they did, they'd have real insurance). I chose Humana because it was cheaper than COBRA. Should have paid the extra money instead.
I was enrolled in a Humana Supplement beginning 01/01/14. On 10/15/14 I received a notice from Humana, raising my rates for 2015. At that point, Humana had paid $20 in costs for me during 2014. I located other insurance, equally good, for much less money. It was secured on 10/27/14. I contacted Humana to dis-enroll as of 12/31/14.
For the next 3 1/2 months I have been arguing with Humana. On January 3, they drafted the money for January from my account. I complained. Three weeks of daily calls and arguing passed before a check was finally issued on 01/28/14 to reimburse me for the money they had drafted. However, by the time the check reached me, I also received a call from Humana accusing me of inappropriately getting a check from Humana for money I actually owed them. The call was accusatory and threatening.
On 02/06/15 I received a letter from Humana stating that my application for supplemental insurance was being denied. It went on to say that, in my application (that I had never submitted) I had agreed for them to use my PHI to complete and underwriter review. That was a lie and a HIPAA violation. Finally I sent out letters to the Ethics board, the insurance commission, and the Board of Directors at Humana as I have all of the communications as evidence of this fiasco.
Sure enough, I received a letter dated 02/10/15 saying that they were disenrolling me, effective 12/31/14, followed by a second letter, dated 02/11/15, saying that my application for supplemental insurance had been denied, based on the fact that I had provided them with permission to access and use my PHI to facilitate underwriting review and based on the information they received, I was being denied coverage.
At this point, it is clear to me that the denial letters are punitive, a way to punish people who disenroll from their coverage. They are clearly violated HIPAA regulations and should be prosecuted for those violations. Further, the company functions in an atmosphere of the most uncaring, ignorant, disrespectful, dishonest employees imaginable. I will not be satisfied until Humana is publicly prosecuted for HIPAA violations and publicly humiliated for the way they do business.
WEST PLAINS, MISSOURI -- I had Bypass Surgery and my wife thought we "Had" to have a prescription plan. She purchased the Humana Plan. They did not inform her that there was a $300.00 deductible. We do not use $300.00 in prescriptions a year and, we had a drug plan with the hospital where my wife works. Asked Humana for a dis-enrollment. They agreed to dis-enroll us on 07/31/2012 and sent us a letter of confirmation. Approximately 1 and 1/2 months later I received a phone call from a "Collection" agency, stating that Humana had turned us over for collection.
We had NOT received any statement, bill, or any correspondence from Humana since the letter of confirmation. We never used their plan and paid 9 months plus 2 more to the collection agency. I did complain and got a phone call from Humana, apologizing for the mix-up, but the damage to my credit was already done. I had prior to this a 780 score. Don't know now.
Oh my, where do I begin! Words that come to mind - deceive, misdirect, allude, conceal - a thesaurus may not include all the words! Alluding to drug coverage that in reality is negated simply by the average person's non-medical knowledge. I believe Humana uses this to their benefit. Likely the worst customer service representation in the medicare insurance industry. I feel deceived by Humana's promotion of varied programs that are touted as saving money. Actually, if you become ill most likely you will pay far, far more than you anticipate. Website and paperwork is over the top complex.
For the most part your annual medical needs change year to year. Humana appears to counts on this by fine lining specific drugs for coverage. Never belief Tier One will cover your new generic drug as most likely it will not! Or that the antibiotic you need will be on their list of covered drugs or that that new drug that has been FDA approved for your new/old condition has any coverage at all even prior to the "donut hole" or with a physician's written, faxed approval in addition to the prescription.
Just because the drug company states its generic has no influence that Humana will cover it; has to be on a small Humana 'preferred' generic list that seems to be nowhere out there in cyberland. I find medicare drug coverage plans in general (other than and including Humana) are no replacement for what you had through your employer or what you became accustomed to with the standard insurance industry. Humana creates paperwork your physician needs to fax to them to get a basic long time FDA drug approved for you. After that you relax. Don't do that!
You can never speak with the same person twice as they have no extensions; just a hundred or so phone employees (by their admission) that have a list of rote answers Humana has given to them. You can talk in circles for as long as you desire but more than likely your questions will remain unanswered after you hang up. Humana has surpassed the credit card industry in this tactic.
I thought all I had to be concerned about was the medicare 'donut hole'. Oh my, was I wrong! When the pharmacist stated the insurance carrier said 'no coverage' I was in need of a respiratory drug for a severe case of the H1N1 flu. At $700 I wanted to cry. I changed carriers to Humana to save $20 a month on the premium. Now I have several $45 a month GENERICS on a Humana's Enhanced PDP policy!
I learned today it is far, far easier to get a direct question answered by knowledgeable medicare phone staff than contact Humana. The irony for today is medicare advised me that Humana statements made to me regarding medicare were incorrect; a medicare grievance is being issued! It won't save me from having to continue to pay until I am free to change carriers. However, Humana may be getting their hand slapped by medicare. AMEN.