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I needed a series of three hepatitis B vaccines for nursing school. I called my prescription drug insurance to see if it is covered. They told me since it is a vaccine and not a prescription, it would have to be covered by my medical insurance.
I called Humana and asked if this is covered. They told me yes it is covered. I had to pay upfront and then send them the information and they would reimburse me. I asked are you sure? The rep told me yes I am positive. I then asked to speak to his supervisor. They supervisor also assured me that it is covered.
After the first vaccine, I sent the information to Humana and waited. I received nothing but they told me it may take a long time to get my money back. After I received the second two shots Humana denied the claims. They told me the Vaccine is considered a prescription and my prescription drug insurance would have to cover it.
I argued back and forth between Humana and my prescription drug insurance for six months. Then, I was told by Humana too much time has passed so they will not do anything more. I just lost the $300.00.
My prescription drug insurance was never in the wrong. This is 100% Humana's responsibility. They agreed to cover it and then denied it. The only mistake I made was not recording the conversation or getting it in writing, but even that may not have helped. A vaccine is a vaccine. It is NOT a prescription drug.
Humana owes me $300! They are either crooks or incompetent or both.
This is the worst Health insurance company I have ever used, and I have used a lot of them. (My company changes providers every couple of years) I have to fight with them on at least half of the claims that I submit. My doctor is considering not accepting Humana because they take forever to pay. I have never had a single problem with any of the other insurance companies in the past. I wish my employer would have picked a decent company for us. Even if it costs a little more, it would be worth it.
The complaint has been investigated and resolved to the customer’s satisfaction.
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I'm the person that calls for prior auths at a large IM practice. I agree Humana is by far the worst to deal with. I never get the same person or answer twice. The begining of this year was the worst ever.
It's a daily task to fax the SAME forms (they never seem to get them?) Fax machine malfunction ? Only to Humana?
Some say the Doc's pick costly RX's & get a big kick back to perscribe them. Let me assure you, NOT TRUE! Doc's are frustrated & invest a lot of "un paid" time typing letter's to fight for people. Asking only to allow them to continue what works. Cutting cost is ok on the heartburn & sleep aides, they can buy them OTC(doc's get denied too) However, to change or just STOP paying for life saving med's for people with high B/P, chol, or a diabetic is just wrong! There are no OTC options for them. I look frustration in the eye daily & feel it myself.
"DENIAL" is Humana's best friend & together they are on a role!
Loopholes
Cincinnati, OH
FIrst of all, you are NEVER guaranteed any benefits by any health insurance company. They can't guarantee anything until the claim is received and processed. If it was written as a prescription and dispensed at a pharmacy, that's a prescription regardless of what the item is. The person above obviously doesn't get it either as independent Athena Health rated Humana as #1 fastest payer, least denials, and highest claim accuracy. BTW, fax is a historically unreliable technology and there's no evidence that it was only Humana not receiving your faxes.
I agree that Humana is one of the worst offenders. The reps at Humana are the least trained members of their staff and reflect it in the advice they give. On their behalf, they are on a quota, so like to get you off the phone fast. To anyone who has a problem with insurance, go to your HR dept first. They are supposed to help you. Second, don't just post a complaint on-line to rant. File a complaint on-line with your state Insurance Commissioner. They do help people. The only way they will file against an insurance co is if they get complaints. Contact your state assemblyman. They will also help.
Never, never go out of network, except in a real emergency. Always go to your PCP and never pay up front.
As far as knowing if something is covered or not, remember everything is based on your policy and medical necessity and that is usually decided by the insurance company. If you use your PCP, though, you will not be responsible if he does something that is not covered. Part of his contract with Humana.
I work for HUMANA. I am supposed to be working with members to keep them well, assist them in preventing ill health. The reality is very different. I chase members down to carry out assessments mDATS and thats pretty much it. My day is highly regulated and monitored and I have a quota of people to reach. If I don't reach that magic number my job is at risk. Around 100 of us were employed to be health coaches and all we really are is call center workers. One of my good friends just killed herself by jumping from the Skyway Bridge over Tampa Bay... She couldn't stand the pressure and constant changes of rules at Humana. Many of us girls at the office have gotten into trouble because members are not interested. Humana is not being fair to the members or the people they expect to sell their rubbish.
Humana by far is the worst insurance company I've had to deal with. I work in HR and we manage 3 different companies. We elected to go with Humana last year because of 30-45% rate hikes yearly with our previous health care supplier. We compared our previous carrier to Humana and they were very closed. BIG MISTAKE! Out of pocket expenses with through the roof. You have to jump through hoops to speak to a customer rep that speaks clear Enlgish. One of my employees has been fighting with Humana for re-imbursement of a prescription that IS on their formulary for 4 MONTHS! You never get a reasonable explanation for anything. The customer rep give you a reason why something was denied and if you can dispute that then they find another reason why it was denied and so it goes on and on ... It's really unbelievable. Words of advice for HR - STAY AWAY FROM HUMANA!