Humana
Reviews and Complaints

Date of Incident: 08/20/19

I am a Healthcare provider and calls Humana Monday - Friday for updates on claims or to find out why a claim denied. The representatives are so rude and often do not want to help with a simple claim status or questions regarding the processing of the claim. They will put you on a silent hold until you get tired and hang up or they will put you on hold with music and eventually hang up on you or wait till you end the call. I have requested o speak to a supervisor and have been put on hold or hung up on and have to keep calling for the same issue with no resolution or either call back and pretend I'm calling for a different reason and request to speak to a supervisor in provider services and that's how I end up speaking to a supervisor. This is so unprofessional on Humana's end on so many levels. I am not the only one with this problem, other billers have this same problem. I had this same problem with Humana when I was at a different company. Someone please look into this as soon as possible. The supervisors obviously has not done anything to change the way the representatives are doing their customers and clients. We have countless claims to follow up on with Humana but can't get through half of them because of this continued issue. Although we have Availity, it's not user friendly when it comes to Humana. It's not like we can send an inquiry through the portal like other payer plans that use Availity. This is causing us major issues trying to do our daily duties during our work day. I am solely speaking of the "Provider Services Department" that handles the claims. The number we call is 1-866-427-7478.

Long story short, my father was taken by ambulance to the ER on august 9th with Acute respiratory failure.after arriving it was found his co2 level was 90%, he was in kidney failure, and heart failure. he also was extremely low on iron and received 2 pints of blood. Our hospital literally fought to keep him in the hospital for six and a half days .they poured meds into him to save his life. He lost over 10lb of fluid in 3 days. He was sent home still in kidney failure. we received 3 letters of denial today.this is their reason(based on Medicare guidelines, the services you are receiving or have received don't require full inpatient admission to the hospital. your record shows that you have trouble breathing because of a lung problem COPD(FYI this is a terminal disease)To need full inpatient admission, you would need to have such things as A severe worsening of your chronic lung condition that does not quickly get better with treatment Severe problems with your thinking due to the breathing problems (confusion, lethargy, or coma) Not being able to breathe on your own (Acute respiratory failure). It goes on to say The records we received didn't show any of the above problems.T he records indicate that you had come to the hospital for shortness of breath .special test x-ray did not show any infection in your lungs.your dr give medications threw the vain steroids and antibiotics .you did not require a breathing tube. It goes on to say he could be treated as an outpatient. Here are the facts he was there because he has COPD(chronic obstructive pulmonary disease)this is a terminal disease.there are 4 stages( he is in 4 )he was put on a CPAP(NOT THE KIND YOU GET ONLINE)his co2(carbon monoxide)was 90%no he was not in a coma or dead and he was not intubated the comment about that was made to me and my mom, they had not seen it before . He did not know me, but he did know my mom, I live with them I am their caregiver, not to menschen the fact he was talking out of his head and does not remember the day of or 2 days after going to the hospital That takes care of the first 2. Not being able to breathe on his own. He was laying there having oxygen forced into his lungs how is that breathing on your own? Then we have (his Xray didn't show an infection ).that is normal procedure it had to be ruled out. What the letter failed to mention were the Arterial blood gases that were done. And this is just the ER, not the hospital stay .there is a whole lot more meds and test run there. the other denial letters are on his oxygen tank rentals and the concentrator, denial again, always the same excuse( service exceeds the maximum number on a single date)So the company changed it to all on the same date .that was wrong to .called and talked to 5 different people they said there was no record of my dad being on oxygen .funny I had the letters for the last 4 years in front of me showing they had been paying without a problem until the last 2 years and this year every other month they pay and I can go back to 2007 to prove it had always been filed the same way . I was promised it would be taken care of .it has not been done. This was once a good company now they are not. I get 4 to 5 phone calls to either change my parent's prescriptions to their pharmacy witch I'm not that stupid. Or trying to get my dad to go to a gym 400 miles away from here, Or trying to tell my mom how to take her meds stupid things like that.
they keep losing the paperwork that gives me permission to talk for my parents. Humana has turned into a big scam.we will be dropping them com October.

Most recent occurrence: 8/16/2019 9:24am
Phone call from number: 888-508-2331

I logon to ‘www.humanapharmacy.com/myaccount' and go to ‘Communication Preferences', then ‘Notifications', then ‘Options'. This is where I can select how I want to receive these Notifications. The Headings are for ‘Humana Pharmacy': Refill Reminders/Order Updates/Order Delays/Important Health and Prescription Information/Offer, Promotions, and Savings Opportunities.

Each Heading has 2 or 3 options: Email / Phone / None

I have chosen ‘Email' for ALL headings, however time and time again, I receive an automated Voice Mail requesting I call 888-508-2331 with an 8-digit code to verify it is me. I have called many departments at Humana Pharmacy, requesting that the calls for the Notifications stop.

This section has given me a choice and I have chosen Email and that is what I want, not Phone Calls or Voice Mail.

Please do whatever it takes to make this change according to my Communication Preferences.

Sincerely,
Ellen Fortner

A couple of warnings. There dental coverage is average with other at best. Getting reimburse takes an act of god. But on the other hand there are people in the business world who do not believe in ethics or morals of any type. One such company is Aspen Dental. Long story short. Went to Aspen Dental for a routine check up and cleaning. Asked if they took my PPO and of course they said "yes". Took my card, copied it, did the work and found additional dental issues that needed to be addressed. The bill over $2K when they were done. Second opinion found these supposedly service were not warranted or even possible. Aspen Dental never submitted my claim for services that they did render. Humana has special prices for In Network providers. The dentist was in fact in there list, but Aspen Dental was not. The address was the same as the listed dentist. Only a little deception at this point. After service provided, Aspen finances the full amount of services to be rendered. Services that could not be rendered according to the second opinion. The bill was from an outside finance agency with extremely high interest. Not one bill went to Humana which they claimed they took right up front. Still to date, 6 months later, Humana has not reimbursed me for the services that were covered at 100% per my insurance as stated. Aspen Dental is still in business as of this date. Deceptives business practices, no insurance investigation and no check from Humana. Thankfully this case has been handed over the states attorney general's office with all the documentation stating the facts. Keep all your records, including chats, bills and any communication. Deceptions lurks in the wings of those who will pry on you.

On wednesday july 31, I called trudell's office (I refuse to call her "doctor" after this experience) to make an appointment regarding an injury my wife had sustained after a bad fall. We had to wait till the next day to receive an appointment. Arriving 30 minutes earlier we had to wait for 1 1/2 hrs to be seen and was told we need an immediate xray of my wife's injured wrist. We were told to go home and wait for the lab to contact us. We did not hear from the lab that day or the next day (fri) so we called the office and the phone call was answered by a machine. It is monday now 5 days after the visit and still no return call from the office or from the lab. If the staff has failed - the responsibility still falls on the "doctor". It's her staff! Fortunately my wife injuries appear to be healing. If she had a serious injury we would be in deep... Now. This office needs to be disciplined. This is unacceptable!

Very Bad Service. I will be leaving this rotten service as soon as I can which will be leaving Jan 1, 2020 Can, t get medical service scheduling is often months out. My 1st Dr appointments took 5 months, referrals is a miss, take 2 additional months or more, physicians do not know very much. As to the Pharmacy what a wait of time. they tell you something and then say something else. To get a new prescription, takes the pharmacy 3 to 5 days to process the new medication then 3-5 days to sent it to Post Office then up to 10 days to get it delivered.

I went to see my PCP Tuesday for an emergent visit for abdominal pain. Upon receipt I was asked for a $85 down payment. I told the front desk my copay was only $30. They checked my benefits online and was told your website reflected a high ded policy. So then I myself called in to member services which further delayed my already worked in appointment. The automated system thankfully reflected the correct information and they charged me a $30 copay but asked that I get a rep to either call in or give ref# for the benefits. I called this morning and spoke to a Natasha who did just that. I then asked for a current insurance card be sent to me which was told would take 7-10 business days but she would email me a current one for my follow up appt this week. I received an email with last years card. I called back and spoke to another rep asking that the card again be emailed to which was sent the same thing. She said she would only be able to mail one out which now would take 7-14 business days. I asked about MYHumana website and said that I "should" be able to view the current ins card there and print myself right? NO! I was told that IT would need to fix it and could not give me a time frame as to when it would be done. My frustration level is like a 10 now. I have been paying on this policy for over 6 months, my provider cannot get the right information and now me as a client cannot. I asked to speak to a supervisor at this time. Danielle was the person that would be speaking to me but only after waiting for 25 additional minutes on hold. She was cold! Gave me the same information that the person before did only with less of a caring attitude for the call. I am so disappointed in the treatment I have received for a service that I have been paying on for multiple years.

Since the incident on 04/25/19 that occurred during my dental visit, Humana Federal Advantage Dental told me that they accepted my insurance plan and that Marbella Dental would also accept it. After my visit I paid $50 and now I received a bill from Marbella stating that I owed $83. After my visit I called my insurance company, to where they stated that I should not have paid $50 since my visit on the 25th of April was an emergency. After becoming aware of that information I then called Marbella to let them know what the insurance company had told me, however they said that they would not return the $50 to me until my insurance company paid the $83 to them. So, since April I have been calling Humana Federal Advantage to see whether they were going to pay Marbella for my procedure and or return my money. My experience with Humana Federal Advantage has been terrible, due to dental being taken away from Military Insurance, I had believed that Humana would be a good option for me since it is intended for Federal employees, however the service and treatment to their clients is very poor.

Dr. Walter terminated me without letting me know . H also told the other physicians in his office not to take me as a patient. I am now without a physician and I need medical care.

He also invaded my privacy by letting all the staff in his office know. On my records it specifically states that no one is to be given my information except when they need to know for medical reasons. His entire staff has been given access to my information.

I found this out because another staff member told my husband who is a patient at the same medical facility.

HELP! I need a doctor ASAP as I'm without some of my mediation!

These people are making sure that you are out of medications. They are causing inconvenience, hard ship, and problems. I am about to soon switch back to the pharmacy I was with before. Back in the day before I switched for Humana Pharmacy I always was able to pick up my medications, and they were always available when I needed them after I get refills from the doctor. Because of this poor company, I am down to 10 pills left over, and they are still messing around, pushing paper work around. They do nothing but give excuses that they cannot fill out my prescriptions with a sent letter for denial. If I don't get my medications that I need before my doctor appointment, I am going to be switching back to my old pharmacy that cares about me.

DO I MUST DIE?
The Humana Pharmacy require that I contact them every 3 months to approve the shipment of medication, even when they have a script from the doctor. I am 77 years old and I forget and in 2018 I did miss 3 months of medication. This year, 2019, first they refused to send me one medication, I did complain and the medication was approved until 2021. We are as today June 21-2019 and I did not received this medication. They have a Network that includes Doctors Groups. One Group called Uro Partners, the only one that Humana has with my insurance, refuse to let me see an Urologist. I do not see an Urologist with Humana Insurance since January 2018 until today June 21-2019. Whit no other Group close to me I do not see an Urologist. I did call Humana Insurance and they send me an EMAIL with Doctors for 4 County but my County, Lake, Illinois, has only Uro Partners Group which refuse to let me see an Urologist. My body do not produce TESTOSTERONE and Humana insurance is not providing me to see an Urologist and Humana Pharmacy do not send me to right medication putting me in a greater danger of dying. My primary care Physician is not responsible for this problem, He Send the Script to the Humana Pharmacy and the request for an Urology Doctors.
6-21-2019 I did speak with Debbie at Uro Partners Group Headquarters and I was told that DEBBIE is calling MICHELLE, DIRECTOR of the Group. So far I do not have received any response making my health in more danger. Uro Partners Group is refusing me to see an Urologist because 4 years ago I saw an Urologist belonging to Uro Partner group which is asking me to pay first $50 and now $74 for bills when I saw him. This bills are with a credit collector. The problem is very simple: Humana has no doctors with any other Groups and Uro Partners is not willing to let me see any Urologist of their Group. MONOPOLY?
Ettore

DO I MUST DIE?
The Humana Pharmacy require that I contact them every 3 months to approve the shipment of medication, even when they have a script from the doctor. I am 77 years old and I forget and in 2018 I did miss 3 months of medication. This year, 2019, first they refused to send me one medication, I did complain and the medication was approved until 2021. We are as today June 21-2019 and I did not received this medication. They have a Network that includes Doctors Groups. One Group called Uro Partners, the only one that Humana has with my insurance, refuse to let me see an Urologist. I do not see an Urologist with Humana Insurance since January 2018 until today June 21-2019. Whit no other Group close to me I do not see an Urologist. I did call Humana Insurance and they send me an EMAIL with Doctors for 4 County but my County, Lake, Illinois, has only Uro Partners Group which refuse to let me see an Urologist . My body do not produce TESTOSTERONE and Humana insurance is not providing me to see an Urologist and Humana Pharmacy do not send me to right medication putting me in a greater danger of dying. My primary care Physician is not responsible for this problem, He Send The Script To The Humana Pharmacy and the request for an Urology Doctors.
6-21-2019 I did speak with Debbie at Uro Partners Group Headquarters and I was told that DEBBIE is calling MICHELLE, DIRECTOR of the Group. So far I do not have received any response making my health in more danger. Uro Partners Group is refusing me to see an Urologist because 4 years ago I saw an Urologist belonging to Uro Partner group which is asking me to pay first $50 and now $74 for bills when I saw him. This bills are with a credit collector. The problem is very simple: Humana has no doctors with any other Groups and Uro Partners is not willing to let me see any Urologist of their Group. MONOPOLY ?
Ettore

Was informed that Aspen Dental accepted Humana Gold. the location in Galesburg IL needs to be audited. I was told deep cleaning would be $1000 but since I had insurance, $500. I was not told Humana
Dental did not cover these services. I was seen 4/8/19 for Gingival irrigation, topical fluoride varnish and numerous x-rays.( A young student repeatedly touched my mouth to align the bite tabs and touched walls, etc. with the same hand, never changing the glove, didn't know how to run the machine, spend 30 minutes with her until a staff person came to assist her) Again 5/1/19 for Perio charting, perio maintenance. To date $670 paid. Minimal cleaning. Now received another bill for $109.50 for who knows what for.
My local dentist charges $200 a year for x-rays and biannual cleaning and checkups. I will be going back to him in November. Aspen Dental is over priced and scary.
Please consider a $200 allowance for a reputable dentist and don't offer this poor substitution for dental care. Health Alliance offers the $200 annual credit with a qualified dentist which is a much better option than the over priced fees charged at Aspen Dental.
May consider opting out of Humana if this was the only option. No medical savings here. I was never told Humana didn't cover these services. Would to have these fees dropped.
Please feel free to contact me if you have additional questions. I would appreciate a response.
Betty Nelson [protected]
Member ID H72343509

I called on 06/17/19 to start an OON Gap Exception (pt was a prior ortho surgical patient who showed up at follow up apt with new Humana insurance.) I got transferred at least once and spoke to a rep to start this auth. She put me on hold at one point and the call was dropped (this was around the 30 min mark). I called right back and had to be transferred a few times and did eventually get someone on the phone who apparently could not hear me and hung up on me (this was after 36 min on hold/transferred, etc). Because this was near the end of our work day, I decided I would call again in the morning when hopefully the wait times were lower. I called back today (06/18) to make sure the auth had been started correctly and that all the info needed was there. I did have the automated system tell me that my auth was pending from yesterday but I wanted to speak with someone to make sure there was no info missing - I wanted to give it the best shot to be approved. I, of course, got the benefit rep (why do I always get the benefit rep when I choose the option for auths?) who had to transfer me. I got Yen Yen or Yen Yan, who after hearing me explain that I needed to confirm the auth I started yesterday, simply started a new auth. I didn't realize for several minutes because she didn't tell me this was what she was doing. When I asked her if that was what she was doing, she said it was because she couldn't find the other auth (which must be somewhere because the auto system had it) and because I didn't have a reference number (because the call got dropped prior to this info being given to me). I at that point asked to speak with a manager or a supervisor because she was obviously not understanding what I was needing, despite her and I discussing this for quite some time (total call was over 1 hour long). She put me on hold for a time and came back and just continued to finish up the auth and give me a pending ref# ([protected]). I asked again to speak with a manager and was now told they were in an emergency meeting. I asked her to find a manager/supervisor that I could speak with. She put me on a long hold again and told me that she just s/w a supervisor and he said that I should call back later. I can almost guarantee that this young lady NEVER inquired about getting a manager on the line. I asked her if I could even speak with one of the nurses - that was also a NO. I am absolutely appalled at the customer service that was given. What will probably happen is that your nurses will deny this request because it will look like I am starting this after the date of service. I explained this to the rep and she could only parrot the only info she has to give - fax in notes and they will call you if they need anything. To have a problem so small like this that could not get resolved in several hours over 2 days is APPALLING. The fact that she WOULD NOT transfer me to anyone over her head is very concerning. Please know that that I will make sure that I never use your product for myself or ANYONE in my family. I will tell everyone that I know to RUN from your products. If you can't get a small issue like this sorted out, then I feel for your patient's who are trusting you with their lives.

Upon calling humana I was first meant with a very long hold time with a recording the entire duration constantly repeating that I can go online for assistance. Once I finally made it to a live person after 25 minutes the person got all the information and then stated that I had the wrong department and that I would need to be transferred elsewhere. She transferred me, upon another 10 minute wait time with the repetitive hold recording telling me to go online to only have the live person ask me ALL the same information to only tell me, yet again, I had the wrong department and she would transfer me. I was finally transferred and upon another 10 minute wait time I received a live person who AGAIN needed all the same information. When I was finally almost about to give her the fax number so our office could actually receive the denial letter that was never sent to us, for the previous person I spoke to somehow cut in and stated that she had a live representative. This was very frustrating and I told her I was already talking to someone and almost had things figured out. The two woman than conversed and the previous one finally got off the phone. I was able to relay the fax number. I waited to do the survey, as it stated when I first got on the phone that if you want to wait after the call you can do a survey. I waited for 5 minutes and then the phone just hung up on me.

I was calling from a providers office and if its this difficult and frustrating to get through to anyone than I cannot imagine what your clients have to endure when they call your line.

Personally one of the worse experiences I have ever had to endure when calling an insurance company for such a simple matter.

I changed my supplemental plan to Humana in January 2019 Prior to 5/23/19
A Humana representative called me to ask if they could assist me with changing my RX pharmacy to Humana (mail order for Amlodipin 5mg and Rosuvastatin 5mg), because they could save me money with a 90 day plan instead of 30 day. This meant I would not have a co-pay with the 90 day RX(s) for these two medications. I agreed to the changes. The representative stated she would handle the changes, and she would send a RX to my primary doctor to request the 90 day supply (one of my medication at my pharmacy was already a 90 day supply). On 5/23/19 they sent my first mail order for a 30 day supply of my medication with a co-pay. I called Humana and spoke with another representative for over 30 minutes along with one of the pharmacist at Humana Pharmacy. I thought the matter was straighten out then; but apparently not, because I still have the same problem today. I even went to my primary clinic (nurse practioner) and informed him of the issue of the RX prior to 5/30/19 ( I had already called to inform him of the matter prior to this date). Then I reminded him of the RX on 5/30/19. He gave me a written RX and said he was sending one to Humana pharmacy. Yet, I received another 30 day supply with a co-pay from Humana this week. I called them back today to report the problem, and went through the long explanations with them regarding the problem a third time. And The pharmacist I spoke with today, by the name Ola, repeated the wrong Fred's pharmacy address, in my area to me, which they probably had wrong in the computer? That could be a part of the problems? I don't nowhat their problem is! My point is, I could have stayed with my local pharmacy without all the issues I have experienced with Humana's Pharmacy over the last month. Saving the money was not as frustrating to me as dealing with the pharmacy with Humana! I did not ask for this problem. It appears to be a lack of communication. Now I have a 30 day supply of medications of both of my prescriptions instead of the 90 day that I do not want from them!
That was the sole purpose of changing my pharmacy to Humana Pharmacy! I could have gotten this medication here at home for that matter. Now the pharmacy does not want to take responsibility for their actions! I could have Faxed the RX, but the original representative I spoke with informed me, "No, I needed to do nothing!" It is most annoying to me! And as far as I can see right now, it still may not be corrected! But I did call my clinic again this PM and reported the problem. They have received the Fax from Humana the 3rd time! I need to return these RX(s) and get my right RX(s) sent out to me! ID H62254171

My wife, Patricia A. Nelson member No. H64486787, is having issues with receiving her benefits from the policy. She filed for the policy in December 2018, stating that her birth date was 01/01/1953 and wanted the policy to be in force as of 01/01/2019. Application, as per information of our agent, was lost by Humana. Application was refiled 2 times. On February 1, 2019 she received a letter stating that she was covered as of January 1, 2019. However when she received her member card it states date of issue as 2/1/2019.
She submitted an order for over-the-counter med ans products in February. We have not received a conformation regarding that order. She submitted another order in March for the 2nd quarter. Received conformation and finally received a portion of her order. I called regarding this and was told "She is only entitle to $45.00 per quarter and the order was over that." Her policy states she is due $75.00. In speaking to the agent, I found that they did not have her correct information in the computer. My wife's information was mixed with another client who lives in Madison, WV. I connected my agent, he contacted Humana and it was fixed. Then we started receiving EOB and claim denial forms from providers in West Virginia. I called them. They have the correct information for their client. The EOB and denials have wife's Humana number on the.
I have now received a claim denial for services provided in Joplin, MO which are valid, but Humana has denied them with this statement "This service is not covered because it was performed after your Humana Health Care Plan had ended". Letter dated May 22, 2019, service date May 15, 2019.
I called customer service again today ( call log # [protected] and [protected]) regarding these problems. Again told we will get it fixed.
Currently my wife's over-the-counter med orders are on hold until this is fixed. Also need to have the denial of claim to Mercy Clinic in Joplin addressed.
We are very disappointed in the service we have received from your company. Today I filed a complaint with the Missouri Department of Insurance regarding your lack of interest in our issues.

I am Bobbie Givens. I placed an order the first of April with this pharmacy. I never received the order. This is not the first time that this has happened. I phoned them and was told that the package was sent to Virginia and that it was placed at my door. I am very irritated with this because their was no remorse and no good reason for the mix up. I was told by them to contact my post office to see why I didn't receive the package.

This is upsetting; you had compromised my medical information . Whoever received that package has been privileged to my medical information. There was no concern and I was told that they would send another and it would take an additional 7-10 days. I am more concerned at this point about my medical info being breeched and no one cares. They said UPS delivered to VA. I reside in Louisiana and don't have residence in that state.

Please help, this is a terrible. Why should I inherit the duty to follow up on their mistake? I am a senior citizen and am very careful about pertinent information not being protected.

My sister purchased a Humana HMO policy a few years ago. She was in a terrible fall in January 2018 and sustained a head injury and was on life support for two months. While on life support Tristar medical center reached out to Humana for assistance with coverage of skilled nursing care. Humana denied the claim and stated she would not improve. Fortunately, she woke up from the coma after two months and said a few words. To make matters worse Humana once again denied her assistance for skilled nursing care. We have been told by an Ombudsman that we and others who have experienced this have a case for fraud and should complain to our state's Attorney General office. ...Contact Ann Mikkelsen Assistant Attorney General in the Consumer Protection and Advocate Division: 615-253-3819 or Ann.Mikkelsen@ag.tn.gov

· Contact Commissioner Julie Mix McPeak at Commerce and Insurance. 615-741-6007 or Julie.mcpeak@tn.gov

I got a bill after I went to another company that had better coverage then Humana then I got billed for286.00 that humana did not pay My coverage was for me to pay 40 on doctor visit and I paid it but humana did ont pay there share they are trying to make me pay 286.00 this is their bill and not mine and I get extra help because I am poor to poor to pay this amount! Nancy Sylvain account #1126951 statement date 4/02/19 please do something about this Medicare was informed and they said you need to take care of this.