PITTSBURGH, PENNSYLVANIA -- My complaint is against Humana and its sales associate **. My parents are paying monthly on a policy that is supposed to cover my mother's prescriptions. The above mentioned agent met with my parents in their home approximately 3 months ago. He explained to them that my mother's prescriptions would be covered and that she would not end up in the so-called "donut hole" for a long time.
I am not sure if that is what happened or if this associate lied to them just to make a sale. My mother's prescriptions have not been covered and they total over $500. a month. My parents are in their 70's and do not have the income to pay for her prescriptions so my mother has considered just not taking them. These medications are life sustaining.
I have spoken to Mr. ** and explained to him my mother's situation. He told me at that time that he remembered my parents and he also remembered telling them that my mother's medication would be covered. He told me that the company should cover them and he could not understand why they weren't. He told me he would get back to me the next day after he checked his paperwork.
He did not get back to me, however, he talked to my mother the very next day and told her the same thing. He admitted to her that he remembered her situation and that he did state to her that her prescriptions would be covered. He also stated to her that he could not understand what the problem was. When I called him the day after that he returned my call to tell me that he has been told he is no longer allowed to discuss anything with myself or my mother.
I do not understand what is going on. It seems that either the company itself is either trying to cover something up or just rip off elderly people. Since my parents have paid for months of coverage that they never got but were promised, I feel that they should be reimbursed the total they have paid. I also feel that since my mother has had to pay full price for her prescriptions, that the company promised would be covered but lied, she should be compensated monetarily for the amount that she had to pay due to the company's lies.
Sometime in March of 2010, I found out that my son needed oral surgery for his teeth. I looked on my insurance company website www.mycbfed.com. I located a doctor that was close by to me. His name was ** and he was located at **. I specifically wanted to go close by. I went to this dental office and received an evaluation.
To make a long story short, it turns out that Dr. ** had been deceased. The new dentist no longer accepted Humana. The new doctor's office explained to me that on three different occasions, that they let Humana know this as well. Still to this very day, they have ** listed as well. Humana told me to submit a letter to their appeals office, and so I did. Humana told me that it would take thirty days to process my appeal.
One month later, I called up to find out my appeal, only to have them tell me they never received it. While I did not send it certified, I did send it. I know that they received it because I work for the post office and mailed it myself. Humana simply blew me off. To begin with, this is my second and last year with Humana. I purchased the insurance to help out with my sons braces. I figured that with this and two other dental insurances, I would not have to come out with much out of pocket. For my sons braces, Humana paid $0. My out of pocket expenses was over $5000.
To top this out, the local dentist that my son was seeing, was having a hard time getting Humana to pay claims. Humana has ripped me off and I believe, failed to live up to my expectations. I did contact the BBB about Humana, but was told that there was nothing they could help me with.
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!
This has to be the worst excuse for an insurance company I have ever seen. No one knows what is going on. No one can ever explain to me what is going on. They do not answer questions. The website is horrible. The list goes on and on.
Lately I have been getting the same email sometimes 2 or 3 times a day exhorting me to get a flu shot which I do not need or want. I have complained several times on their website and no one even bothers to reply. I am sick of being ignored.
Every time I place a pharmacy order there is some kind of problem and my order is delayed or canceled outright. No one ever knows what is going on, and they obviously do not make notes in my record when I call, because their customer "service" people are clueless. I have applied to UnitedHealthcare for 2016 and can't wait until I can tell Humana goodbye!!!
WEATHERLY, PENNSYLVANIA -- They didn't pay all the bills they are responsible for. I don't even use the plan much because I hate going to the Doc. I started getting bills that they recalled the money from the Doc. I tried to contact them and they said, "You have two insurance companies." I said that they are incorrect. I spent numerous hours trying to prove they were wrong. I finally did prove it. It turns out that they thought that my dad and I are the same person. Never mind that he is 26 years older than I am, that he has a different SSN and the he lives 800 miles away and these plans are regional.
But, even though I proved my case, they still haven't paid all of the bills they are responsible for. The collections calls are nonstop and they are hurting my credit report. This is an extremely unethical company that everyone... especially the elderly and disabled, should stay away from. Unless you like stress and harassment.
VIRGINIA -- I applied to join their network as a provider on December 23, 2014. The customary time is 60 days if you have everything. Humana reports it takes 120 days. It is Sept. 9, 2015 and I am still not approved. They haven't sent me anything either. I called over ten times and sent 5 emails. Two escalations and two supervisors and still nothing. They have cost me business by not putting me on their panel. I am very angry that it has taken almost 9 months. I can see why they were bought out. They can't provide customer service. I can only imagine what the clients go through.
FLORIDA -- On 12/1/14 I had cataract surgery in Kissimmee, FL - all went well. However, I had Humana health ins a ppo that was my 1st real mistake. This company fights you on everything and they end up getting huge discounts and you end up paying any remaining bal. Come October 1st I will switch to another ins company as Humana is by far the worst I have ever had.
The overall cost of my surgery was appx 6200. They paid about 60% but they should have paid much more. I started out with a $30 ded and it is now up to $50. You can not thru to a customer representative and when you finally do they don't know what they are talking about. Avoid this company at all costs, they are really bad.
Today Saturday at 2 pm Pacific time, I tried to return a call we received from RightSource phone number (855) 250-7660. The representative who answered my call, his name is ** refused to honor the power of attorney that they on file have from my wife to me (Conversation record ref # **). He said, "this medical power of attorney allows me only to verify address." Why people make medical power of attorney to spouse? This Humana is been nothing but headache. They are going to give me heart attack. You out there learn from my suffering.
My wife who is suffering from multiple sclerosis has not been allowed to refill her Betaseron for more than 15 days. The reason...Humana is reviewing her medication. How long does it take? Humana doesn't know. In the meantime, Humana did send her temporary medication.
Today, after being on the phone with Humana for 3 hours and been transferred from one employee to another, with no luck, at the end up talking to a manager there by the name of Deanna (conversation-ref. # **). This manager informed me that I cannot file a complaint over the phone about my dissatisfaction of the customer service at Humana and the only way to file complaint about an employee of Humana is in writing to the grievance department. In the meantime, she advised me to take my wife to the ER to get her Betaseron shots or to go buy it from my pocket. (To whom doesn't know. Betaseron is not a medication that you can buy from a pharmacy.)
Now February is almost over and we could not get a refill. We use to get the Betaseron from Biotech, but this month Biotech informed us that Humana did not allow them to refill it because they want the medication to come from Right Source pharmacy only. The patients should stay without medication until Humana finish their review of the medication. This what you should expect when you sign up with Humana.