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Lost Teeth in Accident and Humana Won't Pay!
Posted by Toothless on 05/15/2007
TEXAS -- I lost my front teeth in an accident. I had to have implants and a bridge for a total of about $16,000. Humana will only pay $400.00. They say teeth are excluded. If I had a broken bone, they would fix it. Are teeth not just bone? And why have accident insurance if they don't pay the 80%? They made me wait 4 MONTHS before they even admitted that I had a claim! This whole time I was in pain and could not eat properly. I've filed a complaint with the state and I have contacted an attorney. HUMANA INSURANCE SUCKS!!!

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Posted by Sarah May on 2007-05-15:
Oh my goodness, I am so sorry to hear that. :( It sounds awful. I assume we're not talking about Humana Dental, right? I can't imagine they would exclude teeth... So it must be health insurance, then. Why $400? Are they covering the cost of different injuries?
Posted by rhondam718732 on 2007-05-15:
I lost my 3 front teeth when I was 12 when I fell on a coffee table. I feel for you. I have had 2 bridges since then (they need replaced every 10-15 years or so), however, $16,000 for the repair is excessive. Maybe that's why they are not paying...
Posted by Pomona Guy on 2007-05-15:
Could you give more details on exactly how you lost your front teeth? This would help us in determining your best course of action. One suggestion would be go to Mexico to have your teeth fixed. They'd probably do it for $400.
Posted by Anonymous on 2007-05-15:
Thats pretty sad when you have to leave your country to get healthcare....Im ashamed to be from the US!!
Posted by Nohandle on 2007-05-15:
Toothless, get back with us. Was this a group hospitalization policy that did not include dental/vision or a separate policy for accidents only with a maximum pay of $400.00? Many companies will cover charges as a result of an accident even though the policy does not include the extra dental/vision.
Posted by jktshff1 on 2007-05-15:
had 4 front teeth, 4 bottom teeth taken out, fitted, replaced with bridges for @ $1,200.00 sounds like he got ripped off by a dentist expecting insurance money
Posted by runaway on 2007-05-15:
Is it dental insurance or health insurance you had through Humana? I know my health insurance will not cover any dental, regardless of the cause. The total does sound unnaturally high, though.
Posted by Anonymous on 2007-05-15:
Under health insurance they consider teeth "comedic". Like runaway says if you want to get teeth fixed, you must have dental. It's just another way they rip you off.

As far ad the price, I have herd implants can cost $10000.00 plus so I guess with all the other stuff they did, well at least you have teeth again.

Sorry you had this happen to you.
Posted by ejack053824 on 2007-05-15:
As long as your alive and ok....thats all that matters partner! :)
Posted by Starlord on 2007-05-15:
I know you meaan cosmetic, lidman, and I think that is ridiculous. When I got my dentures, they took half my teeth each time a week apart, leaving the 4 upper front teeth to hold the shape of the face. Then they said the denture would act as a bandage. I had been living on liquid protein drinks for 3 weeks, and on the way to work, I picked up a big bag of Doritos. Nothing ever tasted so good as those chips.
Posted by CrazyRedHead on 2007-05-16:
I'm not an expert on health insurance but I would think that teeth would be considered cosmetics. But, I am also wondering about the health versus dental thing that everyone else is wondering. You might want to check out the payment schedule for your dental insurance.
Posted by Nohandle on 2007-05-16:
Toothless, you haven't gotten back with us on our questions, but out of curiosity I called our representative from Blue Cross from the office today. We do not have additional dental/vision coverage. She stated if a "natural" tooth (can't be a crown) was damaged due to an accident it would be covered even without the dental insurance. She also stated implants were not covered at all, even with dental coverage.

I'd be interested to know if anyone's coverage includes implants.
Posted by Anonymous on 2007-05-16:
Mine includes nothing to do with teeth (Blue Cross)

Starlord, thank you I did mean cosmetic! Stupid spell checker!!!
Posted by superman15 on 2007-12-19:
That's why theres such thing as dental insurance. It may not be a perfect system, but vision/dental are not part of health insurance.
Posted by Seriously? on 2013-12-13:
My advice is that if you are ashamed to be from the US then MOVE!! It's a shame to have people like you live here and make comments like that just because you don't understand your healthcare. Our laws are changed by guess who? Yep, the man you probably voted for so get over yourself and move on or move out.
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Non Payment of Pre-Approved Surgery
Posted by Goraceax on 07/20/2008
I guess when you get pre-approval from Humana for a surgery their intention is they approve for you to have surgery but they are not pre approving payment for the surgery.

They have held payment based on not having medical history on file, now is that something you do after you have approved payment of before, I think that should have been before.

Then they deny my surgical nurse claim stating I did not have coverage at the time of surgery. The surgical nurse was the one that contacted Humana for pre-approvals before I had surgery, so give me a break!

I have spent the past 10 months trying doing everything they have requested and although they have not denied my claims they are continually finding excuses to not pay them that cost me my good credit, time, and patience. If I would have known they were not going to cover the procedure and cause me so much stress and time after they approved it I would not have had the surgery.

So to all of you considering Humana, don't, find a good company to cover you. My insurance agent signed me up with Humana thinking I hardly use medical insurance, and Humana was cheaper than the insurance I had at the time. Well you get what you pay for, lesson learned the hard way. Pay a little more to have a good insurance company, do not buy into Humana's cheap policy because you will not get good service when you need them the most.
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Posted by Anonymous on 2008-07-22:
On any pre-approval (pre-certification), the message "This pre-certification does not guarantee payment of benefits." The pre-certification only looks at three things: 1) Is this condition covered by this policy?, 2) Does the physical exam show the condition to be sufficient to require surgical care?, 3) Is the surgical care recommended by the physician a covered treatment modality? A pre-cert will not cover any other review of the policy standing (e.g. has the policy lapsed or are some other beneficiary requirements).It's hard luck, but if you had the surgery, you owe the doctor/hospital for the care.
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They Are Not A Good Company!
Posted by 10kim123 on 06/19/2008
FLORIDA -- My Husband and I are middle class citizens trying to make ends meet for ourselves and our 13 year old son on 49,000.00 per year more or less and our employers do not provide health insurance. We do own our home and we are now in our mid forties, so we thought we should obtain health insurance, to protect our son and our home, and our selves, should we get cancer or some other horrible disease. Humana seemed like the best bet three years ago when we signed up for basically major medical with a 2500.00 deductible and a premium of 360.00 per month for just me and my husband (our son has an affordable state insurance that is offered for children in our state THANK GOD). After one year of paying on time and filing no claims, we got a rate increase of 80.00 per month! We were barely able to pay the 360.00!

So Humana offered us a higher deductible of 5,000.00 in order to keep the same premium. Then after another 12 month period of filing no claims and always paying on time, they raised our premium again, this time by 105.00 ! They also said that we were already at the highest avail. deductible, so pay up or get out! Literally crying as I hung up the phone, I decided we would try to pay the 465.00 per month.. after all we'd already paid them thousands of dollars and never gotten sick. If we cancelled now and got in a terrible accident or got cancer, we'd have to sell our home to pay the medical bills. After the gas went up this year and the groceries went up , we were unable to pay the full amount last month. I made a phone payment of 420.00, hoping they would send a late note for the extra 45.00. No luck. They sent a cancellation letter. Now they are CONSIDERING re-instating us, but they are now putting a rider on allergies for me, since my doctor said on my recent appointment that I have allergies and need Flonase. What a scam!

They raise the rates so high that you cannot pay on time and then when you pay late, they look over the records and hold them over your head, saying well ... we might re-instate you after you pay up the money you owe.. but no more coverage for anything your doctor ever mentioned that you have or may have during the coverage period! Lucky Humana! I bet they love it when people pay late and have to get reinstated! this gives them an excellent opportunity to disallow anything that has come up the whole time. Beware cancer patients! Don't ever ever pay late! Humana would rather see you die than pay out another dime for you. They are evil!

In the end they will pay for what they have done to their fellow humans. And what a name HUMANA. yeah right.
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Posted by tander on 2008-06-19:
It's not just you, health insurance is expensive everywhere and the deductibles are quite high. Something needs to be done about it to make it more affordable for everyone.
Posted by Anonymous on 2008-06-20:
Even with my employer offered health insurance, the rate continue to increase yearly. My employer tries to absorb as much of the cost as possible but my weekly contribution still goes up. It doesn't matter if you have ever filed a claim. You are basically paying into a pool with others in your same "risk" category.
Posted by jenjenn on 2008-06-20:
Robf...you're right on!! It's just like car insurance. You pay all those premiums year after year, and never file a claim, but the premiums continue to go up regardless. The minute you don't have the coverage any longer, you would probably need it. It's a necessary evil!
Posted by Hugh_Jorgen on 2008-06-20:
From what I have read about them, you sound like you might be an ideal candidate for a medical savings account.

Basically, you set aside some money each month into this account. A portion of that money buys a high deductible catastrophic coverage plan that will cover you if you have a major illness or injury, but for everyday aches and pains you pay the doctor directly from the money you set aside.

I'm no insurance expert, but it might be worth you doing some research on one of these programs.
Posted by tnchuck100 on 2008-06-20:
A solution that WOULD work:

If 100% of individuals and employers would stop paying all health insurance premiums then doctors and hospitals would be forced to charge what people could actually afford. There would then be no insurance company forking over ridiculous medical fees.

The reason it WON'T work is 10 people cannot agree on any course of action. Much less 150 million.
Posted by Anonymous on 2008-06-20:
Here in Massachusetts, the state recently mandated reasonably priced health insurance for all citizens. You are required to be insured. I was dubious at first, but when I read a story like this I think maybe it's not such a bad idea.
Posted by Ponie on 2008-06-20:
I don't think your idea would work, chuck. Why? Because everybody would end up clogging the ERs in hospitals even more than they do now. And who then ends up paying for it? You and I do, through our tax dollars. I'm all for preventive medicine, but the reasons for running off to the doctor are getting to be ridiculous. When I was a kid, if I fell and skinned my knee, my Mom would wash the scrape, put some antiseptic on it, apply a bandage--and I'd get a good talking-to about being careful--the 'talk' usually applied with the palm of her hand!

Within the past year, a friend of mine suffered a slip and fall very near downtown Detroit. I was called for 'moral support' and transportation back home from the ER. We spent NINE HOURS in the ER waiting for X-rays and a cast applied to a broken wrist.

While waiting, there was a continual stream of Mommies bringing in little Johnny because he had the sniffles or he fell off his bike, all her passle of kids in tow because there was no other adult who could watch the kids. I got into a conversation with one of the triage nurses while waiting. She told me 75% of the patients seen have no primary care physician--so they come to the ER--and the state picks up the tab.

I certainly empathize with the poster because being self-employed, I, too pay a high premium for insurance. In the 8 years I've been with them, my premium has more than doubled. The only time I had a claim with them, for which they paid very little, was once when a heart condition was suspected and I had to undergo numerous tests to rule it out.

I agree, Hugh, that a medical savings plan should be looked into. However, they're not available in all states, are they? Last time I checked, about four years ago, I couldn't get one in MI. I think I should look into it again.

Ken, have you had any experience with MA's plan? I know Romney touted the plan quite a bit during the presidential debates, and often wondered how it worked. According to him, it was a good plan--but you know politicians--say anything to get those votes.

Good luck to you, poster. I hope you can see your way through this.
Posted by tnchuck100 on 2008-06-20:
Ponie: My plan won't work because of exactly what I stated. People will not agree. You actually supported my reason for failure just now.

Your reason could not be the cause. Most insured patients go to a doctor and all others go to the ER. If there were no insurance for anyone the load would be distributed to the doctors. The load on the ER's would actually be less.
Posted by cherpep on 2008-06-20:
chuck, you make an excellent point about the ridiculous medical fees. On my medical bills, I see what the hospital, doctor, or lab has charged, and then I see what my insurance plan agreed charge is. It's amazing the difference. For instance, for a medical treatment that I received 3x/week, each session was charged over $2000.00. However, my insurance company agreed to pay approx $800.00, and that was accepted. IF IT IS POSSIBLE TO ACCEPT $800, WHY DO THEY CHARGE $2000 TO OTHERS?! I see this on test after test, procedure after procedure. To the uninsured - they would have to pay $2000.00. THAT'S CRAZY AND NEEDS SOME TYPE OF REGULATION.

Sorry for shouting, but I get a little emotional over this topic.
Posted by tnchuck100 on 2008-06-20:
cherpep, you get emotional - I get pissed! You have just pointed out a fact I have never thought fair. And, I don't think most are even aware that condition exists. Those without insurance are expected to pay far more than the insured do. Also, most people have the attitude 'It doesn't matter what it costs, insurance is paying it.' What an asinine perspective!

As with the oil companies, it's just plain greed. The health industry is not about health, it's about money!
Posted by Scrap on 2008-06-20:
I, at one time had Humana as an HMO for the over 65 crowd. The service was great, and there were no increases in the premium. All of a sudden they dropped the plan and left a whole lot of people scrambling to find a new provider. Since that moment in time, I have received junk mail by the loads from them, and have seen ALL kinds of TV commercials espousing how great the are. Frankly, I would not insure my dog house with them. Keep looking on the internet, you WILL find a better deal, AIG ? RW
Posted by Scrap on 2008-06-20:
Hopefully you are looking for another provider.RW
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Big Brother HMO
Posted by Eimken on 03/09/2012
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 mercey of a review panel deciding what is best for her.

sad daughter 3/9/12 12:02PM

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Posted by clutzycook on 2012-03-09:
This story is weird for two reasons. One, was the accident her fault? If not, why isn't the other person's car insurance paying for this. Two, hospitals are EXPENSIVE whereas LTACS SNFs are cheaper by comparison. There's gotta be more to this story.
Posted by jeff on 2012-03-09:
You must fight harder and advocate for her survival.. Remeber , it's cheaper for Medical insurance companies if when they believe the problems are potentially terminal, that we die as quickly as possible. They are a business.. Health and care don't belong together. At the end of the year only profits matter not who you killed to get those profits. Insurance for medical care is immoral .. Look at the rest of the civilized countries. Follow the money.. Fight hard for your Mother
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Say anything to get your money
Posted by Kiteman on 01/19/2011
LEXINGTON, KENTUCKY -- My wife and I both had part D coverage last year through Humana. When the 2011 update book came out it was next to impossible to figure out what if any changes would affect our prescription expenses. So I called Humana customer service. Went through all of our prescriptions one by one with the agent and was told only one of our prescriptions was changing. One of my wife's was moving from tier 1 to tier 2 changing the cost of that prescription from $7.00 to $40.00. Come January What a surprise we got when we went to pick up our prescriptions. The truth was the exact opposite of what we were told. For each of us only 1 prescription was staying the same. so in total 2 prescriptions stayed were they were on tier 1 they other 9 were moved from tier 1 to tier 2 meaning a $40.00 copay for each of those 7 medications. Basically the Humana Agent out and out lied to keep us paying for insurance with them. now we pay them a total of 86.00 a month for prescription insurance and they cover about $70.00 of our prescription costs. When your on SSD income is limited enough without the people who are supposed to be helping you lying to you and adding to your cost of living expenses. When I Filed a complaint with Medicare about this a Humana agent called us trying to tell us nothing had changed in the co-pays. Their only answer was to give us a phone number our Doctors could call an petition for a tier exemption. I think you all know pretty much were that one is going. Now the question we are facing is do we give up prescriptions and suffer the consequences or do we give up eating.
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Humana rip-off
Posted by Trimoon on 02/13/2008
OCALA, FLORIDA -- Insurance companies are a rip-off.

Last November I started researching prescription drug plans. After speaking with several companies, I chose Humana because it is a well-known company, the premium was reasonable and I was assured that my husband’s medication for diabetes would be covered.

I spoke with Mike, Terry, Ramiro and Jessica, just to name a few, regarding the fact that my husband’s prescription was Janumet. I was assured that while the Janumet is not a generic drug, there would be no problem getting it approved by the company’s Clinical Pharmacy Review Board. What a laugh!

I enrolled my husband the middle of December and received confirmation via a letter dated December 27, 2007. Later, we received a letter dated January 7, 2008 indicating that because we had not had a drug plan before, there would be a slight penalty each month (only for that year). That was something we could live with.

A letter dated January 10, 2008 was received providing details of his coverage.

Now comes the fun part. We started the process of getting Janumet approved. My husband’s doctor faxed the prescription to Humana. On January 9, 2008, I spoke with Brian to set up the information to have the prescription shipped every three months direct from their pharmacy and spoke with Tanieri at Humana regarding the forms to get Janumet approved. Humana faxed back a form to be completed, which the doctor’s assistant did on January 9, 2008. On January 12, I spoke with Deana at Humana to see if the form had been received (no, so the doctor’s office again faxed the form). On January 14, I spoke with Sandy at Humana to determine whether everything required had been provided. I was informed that the form had not been received. The doctor’s office again faxed the form.

On January 22, Robert at Humana said the form still had not been received. However, we did receive a one-month supply of the Janumet with the notation that no more would be shipped until the proper form had been received.

The following people and the dates I spoke with them give you an indication of the efforts I have made regarding getting the Janumet approved: Nicole (January 24) (the doctor’s office again faxed the form after being told it had not been received); Jeannie and Veronica (January 25); Alisha (January 28); Latosha, Donnie, Esther and Deanna (January 30); Francisco (February 4) who indicated the form had been received and was in the process of being reviewed; Danielle, Evy and Tina (February 6) (when I learned that no the form had still not been received despite being faxed by the doctor’s office five times).

I spoke with the doctor’s office on January 30 and was told they would again fax the form and then call to make sure it had been received so there could be no further delays.

On February 12, 2008, I called Humana and spoke with Amanda who transferred me to Sue. Sue confirmed that the form had finally been received but the authorization had not come through. I stressed the importance of getting this done since the medication was running out. I indicated that my husband had taken several drugs prior to Janumet and the Janumet was the one that worked. I told them that he really needs the drug. He already suffers from nerve damage in his feet due to uncontrolled diabetes.

Sue put me on hold for quite some time and then came back to tell me that the Janumet had been denied. She said Humana was not convinced that enough other drugs had been tried. I explained that I had been told that there would be no problem getting the Janumet approved and that that was the only reason I had signed up with Humana. She said this was not the first time she had heard that. While Sue was very sympathetic, there was nothing she could do.

Needless to say, I am going to cancel Humana. Since the enrollment period has expired, there is little hope of getting another plan in place this year, though I plan to try.

I think it is terrible that representatives of insurance companies can tell someone something, have them enroll in a plan, and then completely disregard the information previously supplied. A patient’s doctor should be the one to make the decision as to medication required. Diabetes is a terrible disease. When a medication is found that can control the disease, there should be no question of it being covered. Everyone knows the damage that can result when it is not controlled. Insurance companies are only in the business for the money. They try to push off old and outdated drugs on the unsuspecting public with little regard for the effects.

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Posted by Anonymous on 2008-02-13:
Humana was the first for-profit company in the health care field. Nothing has changed. They will rot in hades someday, along with the execs from AOL.
Posted by tnchuck100 on 2008-02-13:
Fact: It's not about you or your health care. It is 100% business and profit!
Posted by Anonymous on 2008-02-13:
Considering that Janumet was approved by the FDA only last April, Humana probably sees it was too new and there;s no generic version. But like stated above it's all about profits.

You might be able to fight their refusal through your state attorney general. An insurance company cannot refuse unless the medication poses a danger.
Posted by Suusan B. on 2008-02-13:
You need to have your husband's doctor fight this one - - he needs to provide information that supports the fact that other, less expensive drugs have been tried and that Janumet is the only one that improved your husband's condition.
Posted by Flute726 on 2008-02-13:
Wow, Humana runs a huge risk of being sued by denying patients medication. You are correct when you say that they shouldn't be making the decision, it should be the doctor who prescribed in the first place. I would have them reported to the state attorney general and get started on court proceedings.
Posted by Suusan B. on 2008-02-13:
Humana is not "denying patients medication" - - they are forcing the reviewer to go through their approval process to receive coverage on this particular medication. Per their website, it's called "Prior Authorization" and it requires the doctor to prove that less expensive alternatives have been tried. Calling the state attorney general or starting court proceedings isn't going to change the fact that it is the consumer's responsibility to make sure they understand what they are signing up for and get the terms and conditions in writing.
Posted by Anonymous on 2008-02-13:
Google "Humana wrongful death" and holly smokes. I certainly wouldn't do business with Humana but then again I value my health.
Posted by legal1947 on 2008-02-13:
According to the above statement, all of that was done prior to joining Humana. I agree that "Prior Authorization" was required. HOWEVER, they obviously denied the prior authorization after being provided the documentation by the doctor. It also appears from the submission above that Humana was playing the FAX "SCAM" by denying receipt of faxes, which they are well known to do.
Posted by Flute726 on 2008-02-15:
Suusan B., you need to read the review thoroughly before you say what you did. She already sent the authorization letter in, and they denied it.
Posted by Anonymous on 2013-10-28:
What a lying thieving scam of a company Humana is!!!!!!!!!!!!! I will stay as far away from Humana as I possible can and will spread the word!!!!!!!!!!!!!
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Denial of Claims
Posted by on 09/26/2007
I went to see a therapist for help with mental health issues. I called Humana/CorpHealth to see who I could go to. They gave me a referral to someone who was in network. After checking Humana's website a few weeks later, I found that the claims had been denied and Humana claimed that this therapist was "out of network".

Pretty funny, when I can find her on THEIR provider website of authorized providers.

I complained to Humana and to Corp Health, who takes care of their mental health referrals and again verified this provider was in network.

They have paid 2 of the 5 outstanding claims, the others are "Pending". Now, I get a letter stating they want to have a "panel review" to review "my concerns".

Apparently insurance companies can legally not pay their bills. There is no federal agency to complain to, you have to complain to your state, which I did. Humana will find any excuse under the sun to hang on to their billions and not pay the consumer- and I got my referral from them! Good thing it wasn't a heart attack. I'm sure if it was, I'd have another one when Humana denied the claim.

All Humana had to do was to verify what I told them was true. So, I guess they like to use stall tactics and not pay claims. Must be rough, when Humana raked in 3.2 billion last year! Maybe that's how they get their billions!

They could have done an internal review, verified that this provider was in network and paid the claims. That's it. That's what Humana agreed to do through Corp Health. And that's exactly what Humana did NOT do.

Humana still has not paid my claims after multiple calls, emails, letters and complaining to the state.

Must be nice, Michael Benedict Mccallister (Humana CEO) to have billions of dollars. Humana has consistently received over 100 complaints in my state for the past 3 years every year, and I'm sure it will go higher.

One can only hope Mr. Mccallister will have a serious illness and that his insurance company will deny him!

Then maybe you will know what your customers go through when your company denies claims that you said you would pay.

Too bad your company can get away with this. As a private citizen, I would be sued for not paying my bills.

Way to go Humana! And you say "your goal is to provide exceptional customer service"?????

You could start by paying your claims.

UPDATE- 9/27/07- Humana has started to process more of my claims after a month of customer service calls, emails, letters and a State Complaint. I was told this morning by someone at Humana Corporate that it was a claims adjudication error - whatever the hell that means. I guess a $3.7 billion company can't or won't make sure their computer system works properly. Maybe they do this deliberately so they can wait to pay on claims. Humana also said they cannot guarantee that this won't happen again and that "no billing system is 100% accurate"! Guess yours isn't you g-damn spawns of satan! Such a helpful company when it comes to NO-customer service. Hope you're as sick as I am of lame excuses these sob's come up with to not pay their bills. UBH told me the same thing 8 years ago. "Computer error"!

I even had a provider try to charge me for 2002 claims in 2003, claiming a "computer error". When I contacted my insurance, they said there was no outstanding balance on that account. I again had to complain to the State to get this provider off my back. Way to go! Let's just treat our customers like crap and rake in BILLIONS of dollars of revenue. Same crap, different day!

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Posted by Sparticus on 2007-09-27:
I don't like reading these reviews since I just signed up with Humana a few months back! Though so far our Humana Dental has covered our expenses 100%... but our medical is such a high deductible we haven't had to use them yet...
Posted by Principissa on 2007-09-27:
We have the same problems with BC/BS of Kentucky. My husband went to the emergency room that is in our network as well as the providers, also the one recommended through his job, and they didn't cover the physician's fees because the doctor's are considered out of network. So now if we have an emergency we have to drive 35 miles to a hospital that has providers in our network rather than the 5 miles to the hospital down the street. Go figure on that one.
Posted by SickOfShadyBusinesses on 2007-11-14:
All insurance companies use these tactics on a regular basis. That legislators do nothing about it tells you just how much money and influence ins. companies have.
Posted by superman15 on 2007-12-19:
Principissa- If your hospital 5 miles from your house doesn't take BC/BS, you should probably blame the hospital before the insurance company. Think about it, BC/BS is the largest health insurance company in the world. If your local hospital doesn't want to do business with them I'm sure it's not because BC/BS doesn't want to negotiate rates with them. It just means the hospital would rather charge higher rates to consumers and smaller insurance companies that don't have the same economies of scale as BC/BS. The insurance companies are just part of the problem.
Posted by Principissa on 2007-12-19:
Superman, if you don't know what you're talking about don't post. Our local hospital does do business with them. When you have to go to the emergency room, the doctor that you get may not take BC/BS. Therefore you wind up having the visit not covered. Why because in the off chance that you have an accident and get hurt at work, you get taken by ambulance to the hospital, and get a doctor who unfortunately is not contracted with BC/BS. And when your husband is laying in a hospital bed with a concussion because a 40 pound rock fell on his head, those are the least of your concerns. I suggest that if you are going to post, at least use some type of intelligence while posting.
Posted by jktshff1 on 2007-12-19:
Princi, what in the world are you doing to your hubby??
kidney stones, rocks falling on his head...no utilities,
I hope you got good life insurance on him!!! :)
Posted by Principissa on 2007-12-19:
LOL! They had a mine ceiling collapse and the rock split his hard hat it hit him so hard. He was fine though, mild concussion. He was at work the next day.

BTW it's 500grand in insurance!
Posted by jktshff1 on 2007-12-19:
long as it covers the new house
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Seniors Beware of Humana
Posted by Tradewinds on 07/12/2010
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. Web site 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 GENERATICS 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

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Next Time Make Sure You Go To The Right Hospital
Posted by HumanaStinks on 09/01/2009
Last month I had an allergic reaction and fortunately the friend that I was with me was able to call 911 and get me to the hospital. To expound on the seriousness, I my blood pressure was 40/20 when I arrived and they didn't think that I would make it. The bills started coming in and I knew I had a large deductible but one of the things they didn't tell me and I have look through my paperwork and still can't find it, I have 2 deductibles, in network for 5k and out of network for 10k. Well to get to the point. No ONE except for my regular doctor is in Humana's plan. The lady I talked to today said I should have gone to a different hospital. We only have one hospital in my town. I guess my friend should have looked at my Humana card to see where I could go. Also, Humana determines how much they are going to put towards my deductible. My ambulance was over 800.00 which Humana doesn't cover so I paid it, they only credited me with 319.00 because that is the max they will approve. The ambulance isn't in the network so that deductible goes outside the network, so actually my deductible just went to 15k or more. The Emergency Room is in the network but the doctors that were working are not so they aren't covered. I am paying EVERYTHING out of pocket. I might as well not have any insurance.

Humana spends a lot of money making great commercials but they sure don't take care of their subscribers.
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Posted by JR in Orlando on 2009-09-01:
Thankfully you lived. What a gift that is. It can be very frustrating dealing with insurance companies. When I was hit by a car on my bicycle and hurt, it ended up costing me $3,500.00 in co-pays. That made me really look at the terms of my insurance policy. Like most people, reviewing my insurance provisions is far down the list - maybe even below going to the dentist. Perhaps as a suggestion you need to review your plan so that your town's only hospital is included.
Posted by BEJ on 2009-09-01:
Unfortunately that is the way of medical insurance. Bigger deductibles and copays for out of network. However, there are generally provisions for emergency situations/events--they cover you. Were you admitted? Check it out with the insurance company.
Posted by clutzycook on 2009-09-01:
If you went to that hospital because of a life-threatening situation, I believe that's the exception to the whole in-network/out-network thing. The receiving hospital has to stabilize you and then later send you to a in-network hospital. I would fight this with the hospital and Humana.
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Medicare Advantage Plans
Posted by Pamelagal on 03/24/2011
In late October of 2010, I was asked to contact Humana, Inc. by my mother and Aunt. My Aunt had been in this particular health plan for three years and seven months and was having difficulty acquiring cataract surgery. For anyone having a complaint against Humana's Medicare Advantage plans, the point of contact is The Center for Medicare Services in Kansas City, Mo. The telephone number there is 816-426-5783.

The two parties that I spoke with by name are Bob and Sue. This is the federal agency over Humana specifically, and they were very helpful in remedying the problem.
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Posted by Kurizumaru on 2011-03-24:
I'm confused. Unless I'm missing something, shouldn't this be a compliment?
Posted by trmn8r on 2011-03-24:
Well, it is a compliment to The Center for Medicare Services.

It could be viewed as Helpful to people who have complaints with Humana. So it is technically like an informative, I believe.
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