Humana Wisconsin Complaint - Denial of Claims - Health Insurance Coverage
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!