ComplaintsforHumana, Inc.

• Initial Complaint

  03/12/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have a primary insurance with Humana (********). I have had them for five years. Now they are saying they are not primary; **** is supposedly my primary healthcare company I called the other company, and they said they are the primary, but I am not working anymore (goverment job with the post office). I haven't worked in five years. I'm 70 and Humana is the primary health care that I chose when I turned 65. They should be marked as the primary healthcare, not ****. When I called Humana and had **** on the phone in a three way call, the lady at humana said that she would get it taken care of that day. When I called today the person I said it would be pending for 30 days and then they would review it. They have 7 claims they haven't processed.

  

  Business response

  04/10/2024

  A response has been mailed to the member.  

• Initial Complaint

  03/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My mother-in-law's (mom) husband died on 07-December-2023. I, ******* ****, have been helping mom **** * **** with all Humana items. Two Consents for Release Protected Health Information were sent to Humana 09-February-2024 and 24-February-2024 so that I ******* **** can have full disclosure of **** * ****'s account and Humana still has not put me in her account yet. The original consent form dated on 09-February was mailed on 04-March-2024 and still Humana has not called me to tell me I am on **** * ****'s account. Mom cannot see out of one eye and can't hear very well. On 14-December-2023, a letter was mailed to Humana sending the death certificate for ***** ***** his ID card information and asking Humana to pay back **** * **** $894.00 that had been paid on 01-January-2024 and 01-February 2024 for the medical supplemental plan and Humana still has not sent **** * **** her check for $894.00. Mom has also not received her Humana vouchers and I had requested these vouchers and $894.00 from Humana on 14-Dec-2023, 22-Jan-2024, 04-Feb-2024, 05-Feb-2024, 09-Feb-2024, 04-Mar-2024. The representatives are clueless so I ask for a manager and then the manager does not help me with any resolution. This is unacceptable service, mom is 85 years old and needs help. Humana needs to get this cleared up, ensure I ******* **** is on her account and send mom $894.00 as soon as possible. Humana case ID # ************ Member ID ********* Regards, ******* ****

  

  Business response

  03/29/2024

  Please review the attached response. You can give me a call should you have any questions.

• Initial Complaint

  03/06/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  on march 5 2024 My *** sent a presciption in for ****** insulin and the pen needles that go on the end of the syringe for daily use. Well Humana filled the insulin but would not cover the needle ends without authorization which make no sense. Without the needles I can't take the insulin and all of last year that never occured It doesn't make sense and they expected me to pay 54-80 dollars for them. This should be illegal.

  

  Business response

  03/15/2024

  The response is being sent directly to the member. 

• Initial Complaint

  03/04/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I have made numerous attempts to resolve the issue and I keep getting going in circles. The insurance wants me to contact the hospital and vice versa. We had an emergency while on vacation. We selected a hospital IN Network with our insurance. Our claim was processed out of network. The insurance was suppose to make the correct adjustments; however, they have not and the claim from the hospital is beyond final notice. It is not my job to keep the hospitals' credentials correct with Humana. I have made 10+ calls attempting to have the insurance communicate with the hospital to no avail. Case**************

  

  Business response

  04/09/2024

  See attached response from the Business.

  Customer response

  04/09/2024

  
  Complaint: ********
  
  I am rejecting this response because *********** ******** is in-network with Humana.  ********* ******** have contracts with Humana.  We did not render service before checking that we were in-network.  Humana processed the claim as out-of-network. This was for an emergency service.  I submitted the paperwork that entailed the service and date, and I have contacted Humana multiple times regarding this.  Humana, our provider, kept directing me to call the hospital.  The hospital, who I have also called multiple times, show contracts on their end with Humana, direct me back to the insurance.  The first time I contacted Humana the representative of Humana told me this was processed incorrectly and was supposed to re-process this claim as in-network.  I was informed it would be re-processed and I would receive an update within 7-10 business days.  This never happened. 
  
  Sincerely,. 
  
  ****** *********

  

  Business response

  04/15/2024

  See attached 2nd response from the company.

  Customer response

  04/19/2024

  
  Complaint: ********
  
  I am rejecting this response because this bill has already gone to collections.  This should have never happened, and Humana has admitted it was their error.  This should have been resolved in 2023.  
  
  Sincerely,
  
  ****** *********

  

  Business response

  05/07/2024

  Please see attached response from the business.

  Customer response

  05/09/2024

  
  Complaint: ********
  
  I am rejecting this response because the credit agency is still showing the original amount owed.  
  
  Sincerely,
  
  ****** *********

  

  Business response

  05/15/2024

  See attached response from the business.

  Customer response

  05/15/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is the best Humana can do.  We are changing insurance companies.
  
  Sincerely,
  
  ****** *********

  ***If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration. 

• Initial Complaint

  03/04/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I had oral surgery by ** ****** of ***** ******* **** ******* ****** on 4/12/23 at which time I had to pay $2150.00 out of pocket with the assurance that I would be reimbursed once the claim was approved. I started to track the claim process immediately with Humana and with ****. Repeated calls, office visits and mailing of forms and information continued with Humana and **** for SEVERAL MONTHS. Not once were we advised to file a complaint. **** FAILED MULTIPLE TIMES to submit corrected or incomplete information in a timely manner. **** had no incentive to assist us since they had been paid cash up front, and then ** ****** insisted that I needed to have multiple teeth removed and replaced with implants estimated by them to cost $10,000.00. I got second opinions from a medical doctor, a dentist and another oral surgeon, all of whom confirmed that there was no infection and replacement of the teeth was not necessary. Repeated attempts to get Humana to review the claims over a period of several months resulted in them denying a valid claim that was made well within the time frame for a grievance, AND with $1,226.35 remaining in my Dental coverage allowance. AT THAT POINT I WAS ADVISED TO FILE A GRIEVANCE. Today I got a letter from Humana saying that they could not process my claim because it had not been filed within the 60 day time limit, after THEY delayed reviewing the claim for months.

  

  Business response

  03/13/2024

  The response is being sent directly to *** ********

  Customer response

  03/16/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  Humana requires an AOR form which on 3-13 I requested from Humana and have not received.
  As soon as I receive the AOR FORM I will sign it and return it.
  
  Sincerely,
  
  **** ********

  

  Business response

  04/09/2024

  The response was sent directly to the member as an AOR was not rcvd when the complaint was filed/due. 

• Initial Complaint

  02/29/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Auth for a patient's inpatient chemotherapy was requested 9/28/23. Patient was admitted to the hospital for the chemotherapy on 10/30/23 unknowingly without auth due to continued confusion at Humana where our auth department was sent to 3 different Humana departments due to them all saying they do not work on those auths. 11/8/23: auth was denied for "not being medically necessary" because Humana misunderstood our request as needing a skilled nursing facility and not inpatient chemotherapy. 11/29/23: we spoke with a Humana representative who stated she did not see a true reason for the auth being denied except for it being "not medically necessary". 12/7/23: retro auth request was sent with clinical information. 12/11/23: spoke with Humana because they were confused over what we were requesting auth for as well as the dates of which we were requesting auth for. Despite having previously been told, they said they were unaware and had no documentation that the patient was receiving inpatient chemotherapy; provided third clarification and retro auth was sent to be worked on. 12/27/23: was informed we cannot do a retro auth, so sent an appeal. Humana stated they never received any clinical information (though said information was sent 12/7/23). 12/28/23: submitted an expedited appeal to auth department w/ Humana supervisor. 12/29/23: was informed that the appeal was not supposed to be sent to Humana's auth department and needed to be sent to claims instead; was told it was still being worked. 1/3/24: Appeal was still being worked but as standard appeal with due date of 2/26/24; informed that they usually fax over information on determination or if they need more information. 1/25/24: told appeal still pending. 2/8/24: told appeal still pending. 2/27/24: Informed that auth department voided appeal on 2/2 without informing our clinic; rep stated the appeal was never sent to claims dept nor was there any documentation. Please see supporting document for more information.

  

  Business response

  03/22/2024

  A copy of the response was mailed to the complaint. 

  Customer response

  03/25/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  

  I would like you to please refer to the documentation I provided in my BBB complaint in which I address that the authorization was denied due to confusion with your staff who misinterpreted inpatient chemotherapy treatment (due to HIGH risk of renal failure and tumor lysis syndrome - both of which can cause death) for a skilled nursing facility. There are absolutely NO outpatient charges that can be resubmitted because the patient did not receive ANY outpatient care from date of service 10/30/23 to 11/01/23 - which is information that has been discussed numerous times with your staff and also notated in the documentation that I provided.
  
  We had submitted an appeal under the direction of Jennifer in the appeals department, after having originally requested retro-auth (case number *************) on 12/28/23. On 12/28/23, ****** in appeals confirmed the fast appeal case and noted that we would have a determination by 12/31. On 1/3, we were told by ******** that the appeal was no longer being processed as an appeal to auth, but as an appeal to claims. 
  
  Additionally, we were never notified of - nor did we receive - Attachment A or Attachment B, as well as any notification on the appeal being voided.  We have had the discussion over this claim over and over and it appears that your staff does not document, or this would be recognized. We have spoken with more than 11 staff members and 2 supervisors **** *** ***), and every conversation has been a circle with no resolution of any kind. Even before we began the appeal process, our auth team had trouble submitting the original auth request because they were sent to numerous different departments who all said that they do not work on auths. 
  
  This is absolutely unacceptable, and I encourage you to read the documentation I provided in order to finally find a resolution for my patient. 
  

  

  Business response

  04/19/2024

  Please see attached response and allow 7-10 business days to receive payment information.

  Customer response

  04/22/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***** ******

  ***If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration. 

• Initial Complaint

  02/27/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  In October of 2023 I received a letter from Humana that I was going to be out of network for *** ******. I am retired. The retirees of the state of North Carolina got the same letter, but weeks later they received a letter stating they would be in network. I called Humana and all they did was give me the run around and could not explain this. I called the *** of North Carolina and they would not answer the question either. It looks like the *** of North Carolina threatened to pull there business from Humana and they caved in to their demands. Why are they allowed to be in network, but I am not! Preferential treatment or maybe Discrimination

  

  Business response

  03/14/2024

  Please see attached.

  Customer response

  03/14/2024

  
  Complaint: ********
  
  I am rejecting this response because:I really have no choice but to accept. But first, the letter they said they sent explaining what happened , I did not get. I read the letter on this e-mail and it did not address the problem at all.  I still think something happened between the *** of NC and Humana.  But, Humana is a big company with lawyers and they will cover the mistake  Why did Humana send all those letters to all of their customers if it did not affect them?  And when I first called to complain, they could not tell me how or why it happened!  Welcome to corporate America.  Money talks and the rest of us have to pay! Also I asked the person from Humana other than the *** of North Carolina retirees , who else got this exemption?  They could not or would not tell me! 
  
  Sincerely,
  
  ****** ******

• Initial Complaint

  02/26/2024

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  In 2023 I began ********* coverage with an ********* plan thru ****** **********. I also began taking ******** to improve my overall physical and mental health. The drug allowed me to quiet food noises in my head and suppress my appetite. My Dr. prescribed it after much research and consideration. Under my *** ********* plan the drug was $47 per month as a tier 3 drug. The medication along with a better diet and exercise routine improved my health. Beginning last fall, I looked at ********* plans that would allow me to continue my treatment. The *** plan changed their formulary by adding a PA (prior authorization) to ********. I knew that it would not be approved, as I am not being treated for type 2 diabetes. I found an ********* plan thru Humana that did not show a PA requirement, it shows a quantity limit QL which I’m ok with. I called Humana several times to confirm that a PA would not be required. None of the agents mentioned that it “might” need an approval depending on the diagnostic code on the prescription. My prescription has been denied by Humana and my appeals have been rejected. Humana seems to have added a new utilization management restriction of “diagnosis restricted”. This restriction was not on the plan I signed up for. I am a victim of detrimental reliance as the plan I was given is not the plan I signed up for. While I understand that ******** does not cover weight loss drugs, my medication has not been FDA approved for weight loss. The plan itself is deciding to put restrictions on what diagnostic codes it will cover it for. I signed up for a plan that stated and confirmed multiple times that I could obtain my medication as long as the prescription fell within th QL which my prescription does. I am asking for Humana to abide within the plan parameters that they sold and confirmed.

  

  Business response

  03/06/2024

  Upon receipt of this inquiry, a thorough review of the issue was completed. It was determined that the information we have does not tell us what condition the drug above is treating (your diagnosis). The ******** rule in the Prescription Drug Benefit Manual (Chapter 6, Section 20.4) says a drug is covered when the use is reasonable and necessary for treatment of an illness". An appeal was reviewed and denied due to the drug being used to help lose weight. ******** says that drugs for this use are excluded from Part D coverage. Humana Clinical Pharmacy Review (HCPR) reviewed your appeal and did not find the use of ******** to treat personal history of other endocrine, nutritional, and metabolic disease. You or your provider would have to go through the process of a second level appeal as HCPR can no longer help with the authorization of this medication until sixty (60) days after the initial event being denied

  Customer response

  03/13/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  I understand that ******** does not cover drugs for weight loss.  
  

  In 2023, this drug was covered by my ********* plan.  At that time the insurance company did not show a PA.  I paid the tier 3 ******** cost.  When researching plans for 2024 I looked at many ********* plans.  Most plans required a prior approval.  Humana was the only insurance company that did not require a prior approval as shown on their 2024 Formulary.  My first call to Humana on 10/10/2023.  I received confirmation from ******** ****** that the medication did not require a prior approval.  There was no information or indication that a PA may be requested based on the diagnostic code in the prescription.  
  

  The response to my grievance with Humana was that the information was forwarded to a Web representative who would work to update information listed online.  As of March 2024 the formulary remains unchanged.  
  

  Humana is continuing to enroll customers under this false information.  The company  continues to increase enrollment & their bottom line by publishing incorrect & misleading information.  
  

  i have an appeal hearing in April with an ************** *** ***** ** *** ********** ** ****** *** ***** ********.

   I’m asking the BBB to keep this case open as the investigation is not yet complete.

  Sincerely,
  
  ******** ********

• Initial Complaint

  02/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have not been with Humana health insurance for over a month and they keep sending me documents and paperwork and this and that and this and that via the mail and I need them to stop, there is no reason for them to send me anything any further as they are not my insurance company anymore.

  

  Business response

  04/19/2024

  The final response for the above mentioned case has been uploaded for your review. You can give me a call should you have any questions.

• Initial Complaint

  02/13/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  My wife and I moved from the West Coast to the east coast and had to switch my primary care provider. Humana on behalf of ******* did not explain or go over with policy changes and expected pays, co-pays deductibles etc. I was receiving no co-pays. Everything was covered by insurance as soon as I switched over to this primary care provider. I have a bill for everything that I do now. We can't afford that and I have medical issues that I need addressed so I need to switch my insurance back and they said they would not do so for a year. So because of this unexplained policy that makes no sense whatsoever. I can't use my insurance for a year and have to whip my health go so Humana can make more money off us.

  

  Business response

  04/30/2024

  According to ********

   

  Due to security reasons, we cannot access the BBB portal. A letter was mailed to the BBB advising case findings will be provided to the beneficiary directly.

   

  A letter was mailed to the beneficiary detailing our findings

  Customer response

  04/30/2024

  
  Complaint: ********
  
  I am rejecting this response because: I haven't gotten my co pays back and haven't received an apology from the angry hate filled greedy ** ******* 
  
  Sincerely,
  
  ******* ********

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩