LOUISVILLE. KY -- I am a 56-year-old woman who has Humana Medicare. I had a six-way bypass and my surgeon wanted me to go to a rehab facility for a few weeks. I live in a tri-level home with 2 small children in the home and no one in the home to help me with my recovery. I spoke with the benefits section and was told I had coverage for rehab for 20 days at 0 copay and then 156 dollars a day.
After 3 days of waiting for approval finally they called the rehab facility I was suppose to go to and said I was declined. They said my age I should be able to go home. They didn't take my surgeon's expert opinion that I needed to be in the facility. Humana wants your money but does not want to pay for you to have the services you need.
CINCINNATI, OHIO -- DO NOT BUY HUMANA RX INSURANCE! Humana has a cheap monthly charge that they use as a come on. However, there is first a $320.00 deductible to be satisfied. Then, their drug costs are way out of line. For example: I've had to pay $22.00 for a 30 day supply that my previous carrier charged $4.00. I've had to pay $117.00 for a 30 day supply that my previous carrier charged $40.00. They move what are Tier 1 Rx with other carriers to Tier 2 to be able to overcharge for what is clearly Tier 1.
I suffered a complete breakdown in communicating with them. They tried to contact my MD using the wrong phone and fax numbers. Both correct numbers were clearly written on the Rx. Furthermore, I was given two different fax numbers that my MD was to use to contact RightSource. Again - DO NOT BUY HUMANA RX INSURANCE!
AUSTIN, TEXAS -- My Humana policy became effective February 1, 2015. I've been using Beconase since 1989 for my allergies. Each year, I get samples and try the new nasal sprays on the market, but I always go back to the tried true nasal spray that works the best for me. I live in Austin, Texas, the Allergy Capital of the World, and I have pollen allergies. We are currently in the worst season with cedar still going strong and elm and oak starting up. This is the most difficult time of year for me as far as my allergies.
1) Humana Step 1 STALL TACTIC - Decline the request immediately and ask for additional info. Then, when the doctor responds to the request (my allergist submitted the information they requested, explaining why I need this drug I've been using for 27 years).
2) Humana Step 2 STALL TACTIC is Rejecting the information and closing the claim.
I am not clear how many times Humana will decline and reject before they will finally do the right thing - not even sure they will ever do the right thing. But it means that me and my doctor are in for some truly frustrating periods while we continue to try to get this eHealth company provider to do what they're supposed to do for their insureds - to fill the prescriptions the doctor prescribes and says are needed.
Today's Humana can't hold a candle to the old Humana... That company provided healthcare coverage. Today's Humana works very hard NOT to provide the coverage they're contracted to give. Please don't make the mistake I made. Humana is not the company you want or need. Choose Blue Cross or UnitedHealthcare instead!!!
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.
I called in on 1/23/15. Around 12:10pm I spoke with a male in the sales representative in enrollment. I advised him that I had enrolled through the marketplace back in December and they never submitted my application to Ambetter health insurance. I advised I had made my payment though the marketplace and Ambetter took my payment WITHOUT receiving my application. I then stated I went back to the marketplace and switched to HUMANA thinking I was going to get better customer service.
The sales representative told me that the reason I was not active was because I hadn't paid my premium and that I had to pay even though HUMANA did not receive my application. I advised that I'm not to pay the premium until the marketplace sends my application.
At this point I had asked the sales representative for a supervisor. The sales representative told me that I was going to get told the same thing by the supervisor and started to raise his voice. I asked for a supervisor several different times with my voice raised. I told the sales representative that he didn't need to be raising his voice at me. The sales representative replied "well since you're raising your voice then so am I."
I asked for his name 7 TIMES and he never answered me then he put me on hold then disconnected the call. I was just trying to enroll through HUMANA and tell them my situation with the marketplace. I had the worst customer service experience of my life. Very disappointing.
KENTUCKY -- I enrolled in a Humana One after turning 26 and no longer being eligible for my dad's insurance through Humana with a big corporation. I assumed the service would be the same even though the plan may not be as comprehensive. This was a horrible assumption. I have had an issue with them 10 out of the 11 months I have been with them. They have randomly canceled my plan and I didn't realize until I received a termination letter. Charged me the $25 late fee after they canceled my plan.
I used their online payment portal and the balance was never correct and it never would process my payment. Enrolling was a nightmare because they demanded my previous doctor fax over all of her notes about my last visit (I don't even think that's legal). I've spent hours on hold with them. Worst of all, I've never used them for a doctor's visit or prescription. I have sufficient money to pay them every month. There is no way to make a formal complaint, and if I did, it doesn't matter to them. We need insurance reform, not healthcare reform. This is outrageous.
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.
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 **, **, ** and **, 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 ** to set up the information to have the prescription shipped every three months direct from their pharmacy and spoke with ** 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 ** 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 ** 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, ** 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: ** (January 24) (the doctor's office again faxed the form after being told it had not been received); ** and ** (January 25); ** (January 28); **, **, ** and ** (January 30); ** (February 4) who indicated the form had been received and was in the process of being reviewed; **, ** and ** (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 ** who transferred me to **. ** 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.
** 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 ** 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.
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 Corphealth, 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 Corphealth. 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!
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.