ComplaintsforHumana, Inc.

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Initial Complaint
11/09/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I filed multiple claims and they refused to pay.
Business response
11/17/2023
The AOR submitted is not valid. Our response is being sent directly to Mr. *******.
Initial Complaint
11/08/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I Had a procedure done at ****** ******* clinic, I had coverage at time of procedure and Humana is not paying ****** ******* for services performed. This has been ongoing for a while I am needing this bill paid by Humana in the amount of 1248.84......Colonoscopy was performed and IS covered under my medical insurance with Humana.. ****** ***** was Doctor Performing procedure for ****** ******* Clinic
Business response
11/17/2023
We did not have an AOR to respond thru the BBB. The response has been sent directly to Ms. *****
Initial Complaint
10/24/2023
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
My spouse and I are enrolled in Humana Dental and on 6/20/23, we went to our regular dentist for six month dental cleanings. This is our usual dentist, they are listed as in network at Humana’s online site, and the dentist told us they were in network. After the cleanings, we received the Humana EOB and our claims were denied because Humana stated our dentist was not in network. This started a series of phone calls between Humana, our dentist and ourselves to resolve the issue because our dentist stated they are in network and were on our date of service but Humana stated our dentist let their network status lapse from April until July 2023, which our dentist says is nonsense and incorrect. Today our dentist stated they have contacted Provider Services at Humana three times and *****, their rep, has never called them back to resolve the dispute. My spouse, ****, has called Humana numerous times and they will not call us back or resolve the matter. She called Humana on 9/12/23, the fourth call, and their rep, ********* stated she would discuss it with her manager and they would call *****’s boss in Provider Services to find out why our dentist has not been called back and the status of resolution. My wife called again one month later in mid-October and was told ******** would call her back. No one has called us back from Humana. Humana has also not called our dentist back. The dentist said today a lapse is not even possible as they have a contract with Humana. We had to pay $351.60 for two cleanings on 6/30/23 out of pocket to our dentist because of Humana’s obvious mistake and refusal to resolve it. Our dentist was in network and there was no lapse in network status on our date of service. We pay premiums monthly to Humana and they have refused to pay on our six month cleaning claims. At their site today after login, I clicked repeatedly to access and view our clams online, and their online site does not function or show our claims or claims status.
Business response
12/08/2023
Company responded directly to the customer.
Customer response
12/11/2023

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********* and even though, Humana EVENTUALLY supplied us with a written documented response that was satisfactory, it was only after contacting the BBB and filing a claim that Humana took our problem seriously and in all probability would not have if we had not contacted the BBB.
Thank-you BBB for your assistance.

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
10/23/2023
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Earlier this year I filed a durable medical equipment claim with my Medicare Advantage provider, Humana. Initially it was denied but I appealed. They reviewed my appeal: #************ and approved payment. Check #********** was issued March 7, 2023 in the amount of $879.98 payment for claim #820223021060432. I did receive the check but we were in the middle of packing up parts of the house because all of our windows were being replaced. Much to my dismay the next time I looked, I couldn't find it anywhere. I looked high & low but I'm now absolutely certain it was accidentally shredded. I immediately contacted Humana and requested a reissue of it. I was assured that the check was still outstanding and a reissue would not be a problem. By April 17th I still had not received the replacement check so I called again. I spoke with Kiara and was advised that the prior request had not been done properly. She put another one through or so I thought. It is now 7 months and 12 phone calls later and I still do not have my check. I have talked to 3 supervisors and at least 15 different customer service representatives. I've kept track of every time I called this company and who I spoke with but I may as well have been talking to a wall. I am beyond frustrated. Most of these calls lasted at least an hour because I had to be transferred or start all over trying to explain everything that happened. I am worn to a frazzle. Can BBB Please Help me??! My Humana Gold Plus HMO Member ID is *********. Case # ************* & Case #*************. The first case # was created on August 7, 2023 & the 2nd case # was created on August 23. 2023. I will be glad to sign a release form if needed and provide copies of the original appeal decision letter agreeing to reimburse me as well as the explanation of benefits, reflecting the check #, amount, etc. Thank you so much!
Business response
11/08/2023
Please see attached.
Customer response
11/14/2023

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. Humana has reimbursed me in full. Thank you, thank you, thank you, BBB!!!

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
10/20/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Humana administers the so-called Medicare Advantage Plan. One of the benefits is a $100-a-quarter allowance to receive OverTheCounter(OTC) products. One way is to log into the Humana website, select OTCs from there, and have them shipped to one's home. This has been working for a few years, but suddenly, the allowance of $50 means only $25. The allowance of $100 means $75.00. Humana is stealing from senior citizens on a fixed budget!!!!!!!!!!!!!!!!!!!!!!!! In 2023, at the end of quarter 3, my allowance balance was $50.00. I ordered (#: 487670596) two bottles of Baush_Lomb PreserVision Eye Vitamin ($25.00 each), but I received ONLY ONE! My husband's (******* J ******) order #: 487673681 was also short by one $25 value item. My October 2, 2023, order #: ********* was for four $25.00 ($100 allowance) of the same OTC, but today, I received only three (3) items totaling $75.00. Where is the $25 item missing from each of these orders? I contacted Humana online and by phone. It turns out that Humana representatives are poorly aware of the situation. I was told that there is a new $1.45 fee which causes it to be over the allowance, and this fee is: 1. tax 2. shipping charge 3. copay No one would explain why orders are missing items. When I logged into my account, I had a balance of $1.45, and I paid it with my credit card. There are several problems with this scenario: 1. I have screenshots of my orders, and no additional fee is mentioned. 2. If an unannounced fee of $1.45 is a balance to pay, how does this fee cost me $25 (missing $25 value item), and I still have to pay $1.45? 3. Why, during the order process Humana's software is NOT AWARE of the fee, but the fee was added after the order was placed without MY KNOWLEDGE? This faulty Humana's procedure shows DISREGARD for senior citizens and robbs them of $25 on each order (in my case). SHAME! I am asking that Humans implement an error-free ordering OTCs system. If there is a fee to pay, it must be announced at the time of the order with the option to pay it without losing part of the allowance.
Business response
10/27/2023
please see attached.
Initial Complaint
10/10/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
My Dentist recommended upgrading from the Humana "Preventative Value PPO" that I'm currently on to "Complete Dental PPO" which is a step up in benefits. I'm noting that PPO stands for Preferred Provider Organization. The "Preventative Value PPO" offers actual coverage for certain types of treatment, including fillings and extractions. It is NOT simply a "discount" plan which doesn't actually pay for anything but simply offers a discount on services. This past year alone, Humana has paid over $500 towards my dental care. Benefits summary for the Complete plan on the Humana website states ". Prior coverage is defined as an insurance plan that offered coverage and benefits. Discount dental plans are not considered prior coverage." Again, noting that the Preventative Value plan is NOT a discount dental plan. This distinction is important because Humana advertises online "Waiting periods will be waived on basic and major service if member had prior coverage for 12 continuous months." I am a member and will continue to be a member if I upgrade to the Complete plan. I will have had coverage for 12 continuous months and am NOT on a discount plan. When attempting to upgrade my plan, a licensed agent advised that while the discount plans are exempt from this "waiving of the wait time", his notes also explicitly state that the Preventative Value plan also exempts this. When queried as to the discrepancy between his notes and the website, he kept saying he was a licensed agent and this is what he was told. He had no control over the nationally published website and the Benefits Summary that was posted there. He recommended I speak to customer service who simply hung up on me after I explained what I was looking for. There does not appear to be any contact info that will get me to a person that can reconcile this discrepancy.
Business response
10/19/2023
See attached response.
Customer response
10/20/2023

Complaint: ********

I am rejecting this response because: it incorrectly states a signature was not present on the form. As you can see from the attachments here, a signature WAS present. These are the two attachments provided to the BBB.

Sincerely,

**** ********
Initial Complaint
10/06/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
02/28/22;03/04/22;03/07/22;03/11/22;03/14/22;03/21/22;03/28/22;04/01/22;04/18/22 04/26/22;05/02/22;05/25/22;06/15/22 These dates of service were for PT for my son. ***** had surgery on 12/31/2021 for a separate injury that used the initial 20 PT visits. as such when we were notified that the 20 visits were exhausted, the doctor contacted humana to get additional visits approved. humana issued a prior authorization for those visits but failed to pay the bill when the bill was sent. i was not advised until August of 2023 that the bills were not paid. Upon calling Humana they advised that there were not going to pay the bills because he exhausted the 20 visits. even though they approved the additional visits and as a result we continued to take him. Thjey approved 87 visits. When i spoke with them in August they told me i needed to file an appeal on my own even though the clinic had attempted to resubmit the bills. so i did just that i filed the appeal, only to be notified that my appeal was only allowed to be filed within 180 days. i called humana oday and they are saying the auths come from their 3rd party company and not from them. as a consumer how am i supposed to know that when my doctor gets auth from my insurance that they do not have to honor it. i like most consumers believed that the doctor was getting authorization directly from them. also when i called in august the rep never mentioned that i was past an appeal period, further wasting time. its not right. i would have never continued to take him had i known it would not be covered. they bait and switched me. giving us the auth but refusing to pay is not right at all. Authorization***-***-****is what is showing on the Humana member page for visists between 03/15/2022 and 06/15/2022 but they denied every claim
Business response
12/05/2023
The business responded directly to the customer.
Initial Complaint
09/27/2023
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
August 1, 2023. 2078.97 Humana stated that Hearing services that to get Hearing Services that I must go through Tru-Hearing. And their would be a 650.00 co-pay per each Hearing Aid. As due to issues to length to detail I did not use Tri-Hearing. As such I used a licensed Hearing Aid dispenser at Sam's Club and spent 2078.97 for two hearing aids. Humana claims that Tru-Hearing will not approve this as did not use their provider. My username is with Humana, not Tru -Hearing. I have now received from Humana a Annual Notice of changes for 2024, in these changes it lust Hearing ser ices, which I would assume includes Hearing aids. They list for 2023 a 10.00 co oay for in network an 40% of total cost out of network with 2024 they list in network of 20.00 co pay and 50% of total cost for the total. So why did they tell me a 650.00 co-pay for each Hearing audiologist total 1500 for two, and no mention of Tru-Hearing or having to use them only. So explain why if their is in Network and Out of Network as in their Notice of changes for 2024 and showing 2023 coverage did I get a denial of any reimbursement and even appeal g thus apparently it gas been denied. Their is nothing stating Tru -Hearing for 2023 and only 10 co pay in network and 40 % for out of network. WHT have I been denied and no reimbursement, paperwork and receipts were sent to Humana in Lexington Kentucky. But no reimbursement. Seem they gave one policy then change when convenient
Business response
10/13/2023
Our response was sent directly to the member.
Customer response
10/20/2023

Complaint: ********

I am rejecting this response because: Humana seems to want to outsource so m e of their benefits, such as hearing and make you use one supper and company wheras other benefits have a in network and out of network associated with them. But Humana seems they do not offer thus for hearing a d m ages you wonder in my opinion what do the get for making Tru-Hearing and no one else their sole supplier for hearing aids. Need or strongly consider the ethics of Humana and going forward into ****

Sincerely,

**** ********
Business response
10/27/2023
Humana's response has been directly mailed to Mr. ********.
Customer response
11/01/2023

Complaint: ********

I am rejecting this response because: Humana is abusing the system, and trying to circumvent the system. My insurance is with Humana and as such they are suppose to have in network and out of net work. But yet they continue to advertise hearing benefits. They apparently don't have any hearing benefits, Tru Hearing is the ones to have this benefit, thru Humana. This is only one of several instances that Humana is abusing the Medicare Advantage system. They are losing my family due to their ways in 2024. Even 8n network doctors your co pay is out of line!

Sincerely,

**** ********
Initial Complaint
09/14/2023
Complaint Type:
Customer Service Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Centerwell Pharmacy, 9843 Windisch RD, West Chester, Ohio 45069. phone 18004862668. They have charged my account with a $5 copay which is not correct. Enbrel support card pays entire $100 co pay as note on their invoice dated 8/31/2023. The person taking my call for the original phone call insisted on $5 copay incorrectly & could not put me to their finance dept. Tried for appx 1 hour to get several people at Centerwell to transfer me to billing or finance, and they constantly and consistently ask me the same questions over & over, then put me on hold, then another person comes on and we start all over again until finally you are forced to hang up. It almost seems as this is don on purpose, but I cant believe that. There are some people there who are fantastic in service, such as Ms ******* **** who has helped me in the past. But this company has made it impossible to reach someone that can help. Now I have to file a BBB complaint over a $5 bill!!!!!
Business response
09/21/2023
See the attached response from the business.
Customer response
09/21/2023

Complaint: ********

I am rejecting this response because:

Humana and Centerwell Pharmacy now owes me $10, not $5 as previously stated. They incorrectly billed me for another month and another $5. I talked to Centerwell and they are suppose to refund the $10 and charge me correctly from now on. Humana has not been of any help whatsoever with this problem: I have received no call from anyone that I could talke to.. It is extremely difficult for me to answer in this manner due to my condition. Please have supervisor call me. You have my phone number

Sincerely,

****** *****
Initial Complaint
08/30/2023
Complaint Type:
Customer Service Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
My health insurance Humana canceled a dental plan that I did not cancel. When I called before the end of last year I was told everything would remain the same I’m supposed to have four visits for teeth cleanings per year. My dentist office just notified me my plan only has 2 cleanings a year I’m supposed to have four. I was very clearly told I nothing about my plan would change Then they went in and deleted an optional plan I had without my permission
Business response
10/07/2023
Response has been sent to the member.
Customer response
10/10/2023

Complaint: ********

I am rejecting this response because: I already sign a form giving Humana authorization to talk to the BBB. Seems like they are only trying to keep the responses non-public.
when I talked to a Humana representative a while back they could not even find my supplemental dental plan they canceled without my permission and even said I never had a plan that covered four (4) dental cleaning visits that my dentists can prove different . My dentist has the visit dates in their records
I called in 2022 before the end of the year, to make sure ALL of my plans would remain the same, and after the first of the year of 2023 and I was told nothing had changed. Yet they had completely canceled my plan which if I needed to use it I would not even be able to afford the procedure. Had they really wanted to settle this, they would have responded to me…, they could have called me at the same time they responded to the BBB. I’ve had too many UNNECESSARY conversations with Humana The first time I got the dental plan years ago , I was on the phone for well over 4 hours because even the first four supervisors said it did not exist! How can they not find the plan that was being paid out of my disability that they had already paid claims on and and have absolutely ZERO idea what I’m talking about? Humana, like most other health care plans, has departments that have no idea what the other department is doing. This should have been a one call thing that they said oh sorry, we don’t know how that happened we will reinstate that plan but instead they said they could not add it because I can’t change plans during the year yet I was told I can because of my government assistance I get that I was already told from a previous complaint I can change multiple times a year if I wanted
They apparently hire people that have no idea how to look things up or their tech design of their own system won’t let them look things up
Sincerely,
****** ***********
Business response
10/16/2023
The response was sent to Mr. *********** as we do not have a valid AOR on file to allow the BBB to act on Mr. ***********'s behalf. We cannot accept electronic signatures on an AOR.
Customer response
10/19/2023

Complaint: ********

I am rejecting this response because:
I have called the person in the letter and left a message days ago I have got no return call yet.

Sincerely,

****** ***********

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ComplaintsforHumana, Inc.

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