ComplaintsforHumana, Inc.

• 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,
  
  ******* ********

• Initial Complaint

  02/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On 2/5/2024 I called Humana to make an arranged premium payment of $22. The agents name was ****. I explained that I had made a $22 payment in January and I wanted to make a $22 payment for February. She acknowledged seeing the January payment for that amount. It turned out $248.80 was taken from my account. This is why arrangements were made for $22. Because of this error It’s a problem for me to fill my other obligations. I,m on a fixed income and some of that money is to go toward copay for medications and other bills. I’ve been dealing with this almost a week.248.

  

  Business response

  02/21/2024

  Upon receipt of this inquiry, a thorough review of the issue was completed. Your complaint was sent to Humana’s Billing Department for review and resolution. It was determined that your original balance was $248.00. The telephone call you made to Humana on February 5, 2024, was reviewed and it was confirmed that you only asked to make a payment of $22.00 for February 2024. A credit card reversal request in the amount of $226.80 has been submitted. Humana’s Billing Department has written off the remaining balance of $226.80 because the Customer Care representative did not inform you how much was being paid, and only provided you with the confirmation number of the payment. A learning opportunity has been sent on representative as well. Please note, once the charges are reversed it can take up to two (2) billing cycles for it to appear back on your credit card depending on how quickly your credit card company applies it back to your account.

  Customer response

  02/21/2024

  
  Better Business Bureau:
  
  

  I accept the proposal  from Humana,Inc.

  Thank You,

  ***** ******

   

  ***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

  02/05/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 12/05/23 between 11am & 3pm, I called in to verify the amount of my OTC benefits & to my surprise, I was informed that I also had a $750 Spending Account Card that I could use for dental, hearing & vision. I was informed that I had until the end of the year to use it. I expressed to the rep I've never received a card before nor mail notifying me that I even had funds. This was the first time I’d heard of it. I also expressed to her that I had just spent over $500 at the dental office just 2 days prior and if I had known about these funds/card,surely I would have used that instead. The rep was very passive & dismissive. She proceeded to order me a new card and hung up. Feeling uneasy about the call, the next day I learned from another Humana Rep that the previous rep appears to have spitefully canceled the card & a domino effect began causing all subsequent representatives I spoke with to have no option to request a new card again since “the order field still said pending fulfillment” & I was instructed to just wait. I was reassured by all subsequent Humana reps I spoke with that it only takes 2-3 weeks max to send members cards & that I’d surely receive mine in time to use before the year ended. After the 3 weeks had passed, I called again on 12/26/23 at 5:07pm. The male representative told me that if the card didn’t arrive by Friday to call back & they would surely rollover my $750 because of their error [PLEASE PULL THE PHONE RECORD!] I waited as he instructed but no card arrived. I called again on Friday, 12/29/23 @ 3:32pm & spoke with ****. **** told me definitely not to worry & that my $750 would be rolled over because it was not my fault & also that I would not have to wait another 3 weeks for the card to arrive that it would only take 3-5 business days. Her reassurance finally relieved my stress.[PLEASE PULL THE PHONE RECORD!] I called on 1/3/24 & 2/1/24 & now everybody is quoting policy of “no-rollovers.” This is unfair practices & consumer manipulation.

  

  Business response

  02/16/2024

  It was determined that your original and replacement Humana Spending Account cards were mailed to you at the mailing address on file. The original card was mailed on November 23, 2022. You were then sent two (2) replacement cards on December 5, 2023, and on December 26, 2023. It is possible that you may have accidently disposed of the plain white envelope that contains the card and card carrier. You can also contact your local ****** ****** **** ****** *****) and ask why your Humana Spending Account card is not being delivered. Your complaint was sent to Humana’s Customer Contact Center for review and resolution. The two (2) calls placed to Humana on December 5, 2023, was pulled, and reviewed by leadership. On February 13, 2024, a detailed resolution letter was mailed to your address on file. The letter provides the full details of the telephone calls made to Humana with additional attached documents. 

  Customer response

  02/19/2024

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

  Everone is getting this complaint completely wrong. I did not order 2 cards on December 5, 2023. I found out about the card & its benefits on December 5 for the first time. I requested the card at that moment. One of your employees canceled the card on that day and it restricted all other employees of the option of ordering the card again because it said "pending" as if the card was orded and apparently it  wasn't. Both reps on Dec 26 abd Dec 29, 2023(****) both reassured me that the benefits would be on my 2024 allotment for dental, vision, and hearing because of the error. This is the absolute worst case of customer service, mistreatment, and lies I have ever experienced and it has caused tremendous stress and frustration. Humana has failed me horribly and there has been zero accountability because noone is listening.
  
  Sincerely,
  
  ****** *******

  

  Business response

  02/23/2024

  As stated in our previous response dated February 13, 2024, your original and replacement Humana Spending Account cards were mailed to you at the mailing address on file. The original card was mailed on November 23, 2022. The telephone calls you placed to Humana on December 26, 2023, and December 29, 2023, were reviewed. It was determined that on December 26, 2023, the Customer Care representative incorrectly ordered you a new Humana identification (ID) card and not a Humana Spending Account card. I apologize for this oversight. Feedback has been provided to the Customer Care representative. During this call it was not confirmed that the benefits would be rolled over. On the telephone call you made to Humana on December 29, 2023, you were informed that your $750.00 allowance was rolled over and would be added to the card with the $500.00 January 2024 allowance. Unfortunately, this information was incorrect. Feedback has been provided to the Customer Care representative that you spoke with on December 29, 2023. An exception cannot be granted to roll over your 2023 Humana Flex allowance according to the Centers for Medicare & Medicaid Services (CMS) guidelines. This information regarding the allowance expiration is outlined in your benefit material, specifically your 2023 Evidence of Coverage (EOC) on page 55. Humana is unable to provide you with the additional allowance funds. On February 23, 2024, a detailed resolution letter with exhibit documents was mailed to your address on file. 

  Customer response

  02/26/2024

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

  How am I responsible for Humana errors that effected me negatively?

  1st errors made by Humana was on December 5, 2023 when I learned of Spending Account I never knew I had &  requested a card yet somehow Humana reps ordered and canceled the card on the same day. The 2nd error made by Humana was on December 26 as I sat all month waiting for a card I had no idea was canceled, the rep orders the wrong card. 3rd error by Humana on December 29th, I was reassured by Humana rep that my funds would roll over.

  How am I responsible for Humana errors?

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

  Customer response

  02/27/2024

  
  Complaint: ********
  

  
  I am rejecting this response because: 

  How am I responsible for Humana errors that effected me negatively?

  1st errors made by Humana was on December 5, 2023 when I learned of Spending Account I never knew I had &  requested a card yet somehow Humana reps ordered and canceled the card on the same day. The 2nd error made by Humana was on December 26 as I sat all month waiting for a card I had no idea was canceled, the rep orders the wrong card. 3rd error by Humana on December 29th, I was reassured by Humana rep that my funds would roll over.

  How am I responsible for Humana errors?

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

   

  

  Business response

  03/01/2024

  As stated in our previous responses dated February 13, 2024, and February 23, 2024, your original and replacement Humana Spending Account cards were mailed to you at the mailing address on file. The original card was mailed on November 23, 2022. An exception cannot be granted to roll over your 2023 Humana Flex allowance according to the Centers for Medicare & Medicaid Services (CMS) guidelines. This information regarding the allowance expiration is outlined in your 2023 Evidence of Coverage (EOC) on page 55. Humana is unable to provide you with the expired allowance funds.

  Customer response

  03/04/2024

  
  Complaint: ********
  
  I am rejecting this response because you guys have completely failed to acknowledge your errors and zero accountability has been taken on Humana's behalf. This is poor customer care and mistreatment at its finest and will be shared.
  
  Sincerely,
  
  ****** *******

• Initial Complaint

  02/01/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a $200 crdeit with enter **** ******** through my Humana Medicare Advantage plan that I had to use by 12/31/2023. I ordered 2 ****** fitness trackers @ $100 per unit (total $200). I only received on ******. When I contacted *** ******* ***** they created a new order on 12/26 to ship the second ****** but that order was cancelled on 12/27. When I contacted *** about the cancellation they said they did not have the unit in inventory. (Order #*********) I contacted *** again and was told to enter a new order after the New Year and my $100 credit from 2023 could be used. I ordered again on 1/8/2024 (Order #********* _****** *******) and have not received the order. when I contacted ***. I was told my order was under review due to the New Year. I would like a $100 credit to be added to my account for 2024. I have included my insurance benefit info. Thanks *** ******* Your insurance benefits Humana Plan ID: ********* Plan name: *** *** ** ** *** ***** ***** ********** *********** ******* *******

  

  Business response

  02/16/2024

  You can give me a call should you have any questions.

   

  Thank you

  Customer response

  02/20/2024

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

  Customer response

  02/21/2024

  
  Complaint: ********
  
  I do not accept the response from Center **** ******** (***). I was told that the original order for two ****** trackers placed in December was not fulfilled due to lack of inventory. I was told to place the order again which I did in December. When the 2nd order was not filled I contacted *** and was told that I should place another order. Since by now it was January and was concerned that the $100 benefit would not carry over to the new year but was told my credit would be extended into 2024. When the 3rd order was not fulfilled I called and was told that there was a limit of 1 ****** tracker per year. Had I known that was *** policy I would have ordered other items to use my $100 credit. I never received a call in 2024 explaining this issue even after I requested a response via either text or email and no voicemail message was received. I have submitted documentation concerning actual dates. Please keep this complaint open. I have already responded to this issue on the BBB website.
  
  Sincerely,
  
  ******* *******

  

  Business response

  02/23/2024

  Attached is the response to the follow up inquiry. Please give me a call should you have any questions.

  Customer response

  03/04/2024

  
  Complaint: ********
  
  I am rejecting this response because:  The customer states that he has attempted to contact the company multiple times at ************.  Once he talks to a representative, they indicate someone will call him back.  The customer states that he never received a call back from the company.  The customer requests the company provide a specific contact person and their direct line so that he can reach out to them directly and provide whatever information is necessary to get his claimed settled.
  

  Customer response

  03/04/2024

  
  Complaint: ********
  
  I am rejecting this response because:  The customer states that he has attempted to contact the company multiple times at ************.  Once he talks to a representative, they indicate someone will call him back.  The customer states that he never received a call back from the company.  The customer requests the company provide a specific contact person and their direct line so that he can reach out to them directly and provide whatever information is necessary to get his claimed settled.
  

• Initial Complaint

  01/29/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On Sept 11 I contacted Humana Dental about a past due invoice they sent me. My payments were all current and they said to ignore the message. A month later got another late notice even though I was current (bank statements of all payments are attached to this complaint. Called AGAIN, told same thing. Another month went by and they sent me cancellation notice even though I was current on all payments (which they veriified). After calling AGAIN and explaining that I did not want my dental insurance ACCIDENTALLY cancelled, they looked further and found they had set up a DUPLICATE account for with all the same information and benefits. So I checked my bank statements and found they were duplicate charging me (from two of my different payment accounts) at $45.99 each month. So I was told to submit my bank statements by email to their billing department. I scanned and emailed all statements involved (with highlighted errors). and heard nothing for over a month. I called AGAIN and was told to resend my bank statements, which I did. Heard nothing back for another month. Called AGAIN and was told I would get a refund CHECK for my duplicate payments (which would come in 7-10 business days) and according to them was $261.01 and would arrive as two checks. Well 15 business days later I called AGAIN and was told they were WAITING for ME to call and tell them if the refund should be a check or credit. ????????? Really? They never once tried to contact me either (no messages left from them). So I went through AGAIN telling them to send a check. They then said it would be 7-10 business days (from December 9th) It still did not come. I called back AGAIN and was told it would be another 3 business days and that the last customer service rep made an error. Well, it's By this time it was 01/29/2024 and I still have no refund (first contact about this issue was made on 09/25/2023. The amount of lies and inconveience I have had over this issue is incredible for a mainstream insurance company. For anyone for that matter. So, I am requesting BBB intervention to get my refunds and should be done expedited (overnight?) with a tracking number. To be told I have to wait another 7-10 business days would be egregious. Please help. I can be reached 24 hours a day at ************ *** *******************

  

  Business response

  05/03/2024

  See attached response from the business.

  Customer response

  05/03/2024

  
  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

  01/26/2024

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  Copies of claims *************** * *************** Date of service 3/24/2021 Two letters sent, five phone calls totalling an hour and thirty-four minutes of my time, still have not received copies of the TWO claims requested.

  

  Business response

  02/16/2024

  Please see attached.

• Initial Complaint

  01/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Center well pharmacy keeps giving me the run around with an important medication that i take, and then they claim they don't know when i ordered it they can't give me the correct shipping date when i will receive it.

  

  Business response

  02/14/2024

  See attached response from the company.

  Customer response

  02/14/2024

  
  Complaint: ********
  
  I am rejecting this response because now I received a bill dated for 2-7-24 in the amount of 6.99 on account #******. 
  
  Sincerely,
  
  ******* *******

  

  Business response

  02/20/2024

  See attached.

  Customer response

  02/21/2024

  
  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

  01/24/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  A dental procedure was performed on 10/19/2023 and the claim was submitted to Humana. The claim was initially denied due to an address discrepancy despite other claims being approved with the same address discrepancy. Then the claim was denied due to a missing narrative by the periodontist. Then the claim was denied because Humana said they were missing periodontal charting (which the DMD sent in 3 separate times). Then in January 2024 the claim was denied because Humana said it was a medical claim. I sent the claim to my medical insurer who stated the claim was dental. I sent the letter from my medical insurance saying it was dental so Humana could process the claim. Supposed supervisors have escalated the claim to critical and promised outreach to me on the status of the claim. There has been no communication from Humana on the status of the claim despite my continued outreach. Humana has never provided outreach as to the denial of the claim. I have spent hours on the phone with Humana trying to get this claim that's over 3 months old resolved and I am not getting anywhere with any of the offshore call center representatives I've talked with.

  

  Business response

  02/02/2024

  Please see attached response. 

  

  Business response

  02/09/2024

  Please see attached response. 

*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. ↩