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!!!
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.
LEXINGTON, KENTUCKY -- In late April of 2007, I applied on behalf of myself and my then 8-year old son for health coverage with Humana. I received my first letter acknowledging my application on May 2, 2007. The underwriting information originated from Waukesha, Wisconsin. I signed the agreement effective May 1, 2007, and at that time I was 49 years old.
In that same packet of information that I signed and faxed back on May 2, I read in the "Additional Information" pages the underwriter's comments regarding the health status of me and my son, **. The comments regarding my health status were based on a thorough checkup and revealed no abnormalities.
Moreover, the only medications I had taken in the past 24 months were penicillin as needed for dental work. The comments regarding my son were based on a normal school checkup in 2006, and the only medications he needed were miralax (over-the-counter) and antibiotics for an ear infection. No additional medications were needed within the last 24 months prior to our signing with HumanaOne. The whole point of this rendition is to establish that we were, have been, and still are, healthy individuals with no history of excessive filing for insurance benefits.
My "conditional receipt" was for the initial monthly premium of $247.98, applied upon approval of the policy. Again, I am still referring to the May 1, 2007 effective date and the May 2 packet of information faxed to me and then faxed and mailed back to them. I received a letter from HumanaOne dated May 17, 2007 regarding an "application update". In it I was told that my application was approved with modifications, and that I had two days upon receipt to acknowledge the modifications by my signature.
The modifications in the form of an amendment stated that my monthly premium would be increased to $343.90, and the reason given for the "rate up" was "due to body build". I was already committed to this plan, so I signed the amendment effective June 1, 2007. This represented a $95.92 increase from my conditional monthly premium four weeks earlier. Curiously, I had the same "body build" those same four weeks earlier.
In 2008 I noticed that my monthly premium had increased from $343.90 to $390.68, with no prior notice and no reason given. I called and spoke with an individual in the system who could only tell me that the reason was due to me turning 50 years of age (like I really had to be reminded). I accepted that and informed my husband that the automatic debit would show an increase every month by $46.10.
In 2009 I again noticed that my monthly premium had increased from $390.68 to $443.94, indicating a monthly increase of $53.26. When I called to ask why I was told simply that I was a year older, and that each year the premium would increase due to that.
During the past 24 months I have not submitted a single claim for myself. Please see the documents submitted by hard copy to show this. During the past 24 months, I have submitted four medical claims for my son, (doctor's visits) which totaled $278.30. Of that total, HumanaOne paid $20.09, consistent with our deductibles. Also during the same 24-month period, I submitted claims from prescriptions for my son totaling $91.02. The plan paid $00.00, but consistent with the agreed upon deductibles.
My point is this: my medical and prescription needs have been zero for the past 24 months, yet it is my increasing age that supposedly triggers each yearly premium increase. My son's claims have been for normal causes for a boy his age, and not significant by any stretch.
My complaint is the rising monthly premiums assessed each calendar year with the reason being my age. My age has not contributed to one cent in claims and thus not one cent in cost to HumanaOne. I will inquire with appropriate authorities to see if this falls under insurance abuse or age discrimination without cause. I am a housewife and my husband is the sole source of our income. These ever increasing monthly premiums, assessed each year, impact my family and seemingly for no acceptable reason.
COLORADO -- I found out the hard way that every time you speak to someone there you get another answer so make sure you receive everything in writing and believe nothing. Sorry to say but I have serious doubts about the integrity of this company and total love my agent which is why I continued with them this year. But will take a hard look at others for next year.
LOUISVILLE, KENTUCKY -- Because Humana decided not to keep Promedica hospitals in network I lost the Doctor who saved my left foot 8 times and now I am losing the Doctor who is treating me for bladder cancer. I thought insurance was about the patients and not egos!!
WANETTE, OKLAHOMA -- I disenroll in Humana immediately. I was able to enroll the same day online. So it should be that I can disenroll the same way. They require I fax the form in. Why can't they do it by email? I am covered by other insurance. This is official notice. I disenroll in Humana as of February 28, 2017.
GREEN BAY, WISCONSIN -- I have been waiting for a membership card 18 days because of that I cannot even get my prescription filled so I called. The customer service rep I have spoken to was not too bright and told me he would send me the card numbers through email which never showed up. I called. Second time he put me on hold. I was on hold 15 minutes and hung up. They suck!
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.
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)!
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!