Complaint Review: Finance Systems Of Green Bay

I'm sure the only thing Humanarep finds humorous is the fact that idiots like you think that insurance companies avoid paying claims "because they want to" and aren't subject to any sort of regulation.   

You're a moron and an internet troll, Franzg.

I'm glad you find humor in other people's misery.

LOL!

Franzg, you are certifiably insane! I knew you were a hideous liar, but you're saying that Humana has NO customer service department? HA HA HA! Seriously?!?

Where do you think I work for 40 hours a week, you idiot!? What do you think that phone number is on every single member's card and every piece of documentation sent to people?

I hope my company sues you for lying about them. In fact, I'm going to show this to our legal department and see if they can do something with it. You deserve it. People like you that intentionally spread misinformation should be made an example of.

You can't call Humana- there is no customer service or complaints department- you must file all requests in writing to "office of grievance" if you want to contest anything. Please give accurate information, you are no help to the person whose credit was damaged by Humana's mistake.

Yep, just like I thought. Franzg is so scared of being proven wrong he doesn't even want me to look up the case so I can investigate it. It's funny how lazy people are. They'd just rather whine about something than read their EOB's or pick up the phone and ask Humana about it. So sad.

Humana employee, the original post states dental claim paid by Humana. Then Humana sends collection agency after client to collect money from client (not from dentist).

I type these on my own time Franzg. I challenge the member to post the EOB on ripoffreport. Then we'll see what's what.

Better yet, give me your member number and I'll look it up myself.

That's right, Humana employee.

The claim was adjusted, that's for sure, but to really find out why I'd call a rep. You should have gotten an explanation of benefits stating the reason for the adjustment, but if you don't have it, I'm sure a rep can send it to you.

I still see no reason from any of the offered scenarios where Humana needs to hire a collection agency to harass its own client.

Humana is going after the wrong guy in this case. Humana probably made an error. It should just admit the error, and eat the cost.

Let's review the facts.

FACT: Humana paid a dental claim for the member.
FACT: One year later, the payment for the claim was recovered.

This report doesn't have much detail for me to go on, but whatever the reason for the adjustment, I guarantee it was spelled on the member's EOB and the provider's remit. Now, on the off chance that the member or dentist didn't get their paperwork, Humana can easily replicate it.

Some possible reasons for this situation:

1. Humana might have later discovered the patient had another primary insurance
2. The claim might have been corrected by the dentist and thus, had to have been processed differently
3. The dentist may owe money to Humana (for overpaid claims for other patients) and they are recouping funds to balance the scales (obviously this shouldn't effect the patient)
4. Perhaps there is a billing error and Humana shouldn't have paid the claim to begin with
5. Changes by the employer occured in the member's plan midyear.

... that's enough for now. I could go on forever.

Franzg, don't bother blogging back a rebuttal. No matter what possible explanations I come up with, you'll just fire back some "Humana is evil" comment. I'm not fussing with you anymore. You bore me. God himself could come down from Heaven and tell you that Humana didn't do anything wrong and you'd even bicker with him about it. All I'm saying is that Humana won't recoup money "just because they want to". Thinking that they do is absurd.

'I am the law' does not care whether he looks stupid on every post. He is trying to make his factitious case for a long time and never has succeeded yet. This is so simple! Humana screwed up, and now thinks it can collect from their client. How simple is that?

'I am the law' cares absolutely nothing about how stupid he looks to everyone who reads his trash.

What a dough head. The worst I have ever seen in my lifetime. Just think we have a world class 'empty headed idiot' resident right here named 'I am the law'.

Humana made an error

Humana is harassing the wrong person

All claims whether new or adjusted spawn an EOB for the member and provider. Trust me, the dentist knows what happened with the claim. Even on the off chance those documents were never received, a simple call to Humana would explain what's going on.

All claims whether new or adjusted spawn an EOB for the member and provider. Trust me, the dentist knows what happened with the claim. Even on the off chance those documents were never received, a simple call to Humana would explain what's going on.

All claims whether new or adjusted spawn an EOB for the member and provider. Trust me, the dentist knows what happened with the claim. Even on the off chance those documents were never received, a simple call to Humana would explain what's going on.

I see no complaint about an EOB or a "claims adjustment".

I see a complaint about Humana demanding money from a client, and then hiring a collection agency.

Could Humana have made an error?

Ok, first off, Franzg, both of us don't know why the claim was adjusted. Let's assume for a minute that the EOB never got to the patient. (doubtful, but I'll play along.) I see no mention in this report of the author calling Humana to ask the reason for the adjustment or using their website to search for this information.

So, you and the author just automatically assume Humana took the money back "just because".

Do you really think business is conducted that way? Do you really think Humana doesn't pay claims or recoups payments to providers "just because"? Using that logic, Humana wouldn't be number 85 on the Fortune 500, now would it? Humana would have no members at all and no providers in their networks.

Come on, now. Use your head.

Good. Lets sue people who do not agree with managed care.

While were at it, lets try to actually help this client. Now isn't that a novel idea?

You claim the gentleman who posted the original complaint is "lying". That Humana does not try to collect from providers.

I keep reading this gentleman's complaint, and still come to the same conclusion- That Humana paid the claim, and then decided to deny the claim "after the fact".

Is that a lie?

The original post also states that "According to Humana, they then later denied the validity of the claim, after almost 1 year, and then said I owe them money." The original complaint also states "Finance Systems of Green Bay, on behalf of Humana, has blemished a perfect credit record."

It sounds like Humana is trying to collect from the client. It does not sound like Humana is trying to collect from the "provider".

I think your advice is useless, and your argument is flawed.

Now go back to your computer and calculate how many more services need to be cut to improve Humana's "bottom line". You wouldn't want Humana's CEO to receive a smaller bonus next year.

Franzg's response:

"Humana has no complaints department, and would not help the client even if it did."

Rebuttal: This is a lie. It is a federal law that all carriers must have a grievance department. It's Humana Grievance and Appeals, PO BOX 14546, Lexington, KY 40512. Also, the fact remains that Humana pays 99% of submitted claims. Look it up.

"The issue is now in the hands of a collection agency hired by Humana. The client is sustaining heavy credit damage due to a blunder that took 1 year for Humana to attempt to correct. Humana now decides to unleash a collection agent to harass the client."

Rebuttal: This is a lie. Humana doesn't collect money for providers. As for the "blunder" comment, there is a possibility of Humana making an error, sure. But there are hundreds of reasons that payment for a claim may be reversed. Literally hundreds. Franzg is commenting on something he knows nothing about. Chances are it's probably not an error. Both the member and the provider both got new EOB's explaining the adjustment. Again, this is a federal law. Assuming the EOB never got to the patient or provider, a simple phone call or log on to their website would show the same info.

_______ Honestly, I'm sure Humana would be interested to see the lies that Franzg is spreading on this website. Hello civil suit!

Franzg's response:

"Humana has no complaints department, and would not help the client even if it did."

Rebuttal: This is a lie. It is a federal law that all carriers must have a grievance department. It's Humana Grievance and Appeals, PO BOX 14546, Lexington, KY 40512. Also, the fact remains that Humana pays 99% of submitted claims. Look it up.

"The issue is now in the hands of a collection agency hired by Humana. The client is sustaining heavy credit damage due to a blunder that took 1 year for Humana to attempt to correct. Humana now decides to unleash a collection agent to harass the client."

Rebuttal: This is a lie. Humana doesn't collect money for providers. As for the "blunder" comment, there is a possibility of Humana making an error, sure. But there are hundreds of reasons that payment for a claim may be reversed. Literally hundreds. Franzg is commenting on something he knows nothing about. Chances are it's probably not an error. Both the member and the provider both got new EOB's explaining the adjustment. Again, this is a federal law. Assuming the EOB never got to the patient or provider, a simple phone call or log on to their website would show the same info.

_______ Honestly, I'm sure Humana would be interested to see the lies that Franzg is spreading on this website. Hello civil suit!

Franzg's response:

"Humana has no complaints department, and would not help the client even if it did."

Rebuttal: This is a lie. It is a federal law that all carriers must have a grievance department. It's Humana Grievance and Appeals, PO BOX 14546, Lexington, KY 40512. Also, the fact remains that Humana pays 99% of submitted claims. Look it up.

"The issue is now in the hands of a collection agency hired by Humana. The client is sustaining heavy credit damage due to a blunder that took 1 year for Humana to attempt to correct. Humana now decides to unleash a collection agent to harass the client."

Rebuttal: This is a lie. Humana doesn't collect money for providers. As for the "blunder" comment, there is a possibility of Humana making an error, sure. But there are hundreds of reasons that payment for a claim may be reversed. Literally hundreds. Franzg is commenting on something he knows nothing about. Chances are it's probably not an error. Both the member and the provider both got new EOB's explaining the adjustment. Again, this is a federal law. Assuming the EOB never got to the patient or provider, a simple phone call or log on to their website would show the same info.

_______ Honestly, I'm sure Humana would be interested to see the lies that Franzg is spreading on this website. Hello civil suit!

Now it wants client to pay Humana back for the money it spent.

Humana has no complaints department, and would not help the client even if it did.

The issue is now in the hands of a collection agency hired by Humana. The client is sustaining heavy credit damage due to a blunder that took 1 year for Humana to attempt to correct. Humana now decides to unleash a collection agent to harass the client.

I would never stoop so low as to work for a managed care corporation. Managed care is fiscally irresponsible. It is an oligopoly. It is detrimental to our well being, hurts the economy, and makes rich people even richer. It has nothing to do with our health.

We have had our choices taken away from us.

Yeah sure, like I would work for a corporation which forces 500 people to receive dialysis in an arena full of people dropping dead in front of each other, just to please the shareholders.

Managed care is like a sick puppy that needs to be euthanized. It would be the humane thing to do.

I love Franzg's response to this, "Obvious financial error by Humana. Now instead of correcting the error, they abuse the client. Someone at Humana is doing a crappy job, and there is no way to complain. What they are doing is wasteful and destructive, and costs too many taxpayers dollars to maintain.Humana should clean up their act."

Again, he's speaking about things he's not even involved in. Franzg works for a rival insurance company, so his comments mean nothing here.

As for the original post, all claims whether new or adjusted spawn a new EOB for the member and provider. Trust me, the dentist knows what happened with the claim. Even on the off chance those documents were never received, a simple call to Humana would explain what's going on.

Obvious financial error by Humana.

Now instead of correcting the error, they abuse the client.

Someone at Humana is doing a crappy job, and there is no way to complain. What they are doing is wasteful and destructive, and costs too many taxpayers dollars to maintain.

Humana should clean up their act.

I appreciate your knowledgeable response. I believe in this case however, that the following is true:

"Human(a) Dental paid for a claim. According to Humana, they then later denied the validity of the claim, after almost 1 year, and then said I OWE THEM money."

"Now in December of 2008, Finance Systems of Green Bay, ON BEHALF OF Humana, has blemished a perfect credit record. Even after I told them this was a incorrect billing error on Humana's part."

"People at Humana were incompetent and now MY credit report
has been tarnished."

There is virtually no doubt that Humana is collecting from the patient(the author) in this case.

Notice from any collection agency, to an patient, is absolute notice that the patient is being collected from. Not the dentist.

Thanks

Insurance companies normally don't collect medical bills on behalf of providers. "Law" is right about that.

What does happen, and may have happened here, is Humana might have directly paid this claim as a reimbursement to the author if the initial payment to the provider was made by the author, or an issue prevented the provider from being able to accept payment directly from Humana. In this case, most companies will send a check and a notice of why the check was sent to their customer. In that case, if an error was found later, then an insurance company would try to recover the resulting financial error from the author, the same as they would from a doctor if a doctor was paid too much or incorrectly.

It is also possible that Humana recouped the erroneous payment from the dentist, who then employed a collection agency to get the payment for services back. Health care is confusing for many people, and having worked in the industry for a period of time I can say with honesty that a good number of people assume payments for services are sent to the companies, that the Explanation of Benefits is a bill, or that the insurance company owns the practices and facilities used for medical care. It doesn't mean these people or ignorant or uninformed, just that they are confused and understandably frustrated. Nothing is more important to somebody than their health care, and many people want it taken care of.

Earlier somebody had stated about the grievance and appeals mailbox "somewhere in Kentucky". That would be the author's best bet. The Grievance and Appeals Departments exist for situations just like this, in every major insurance company nationwide. Nobody and no entity is infallible, and this department is staffed with people who are trained and advised to research and resolve issues, or at the very least offer a detailed explanation of what happened. The Grievance and Appeals information can be found on the back of most companies' Explanation of Benefits, or requested specifically by contacting the Customer Service departments.

Everybody has a right to ask for a full investigation into the matter which causes a complaint, and it is the responsibility of any health insurance provider to take these complaints seriously. I would urge that route.

Peace.

See what I mean Andromeda?

This is exactly what I was talking about, Andromeda.

"So you want me to secure a document, from a company that I don't work for, stating services they DON'T provide, for every health care provider in America? Um, Ok, I'll get right on that. Pffft."

The author and Humana's collection agency have the only document that is relevant to this ROR.

"If you want to believe that Humana collects for providers, fine."

Why would I want to believe that! Tell me again.

"If you want to doubt everything I say, fine. I tried to educate you, Forrest Gump."

A person cannot be educated by someone who cannot read, and has some wires crossed up.

"Oh yeah, I'm wrong. I guess my eight-year secondary education and Masters in this field was for nothing."

Absolutely for nothing.

"I guess running a billing and coding department in a major Chicago hospital for twelve years makes you the expert over me. I guess they pay me nearly six figures a year for absolutely no reason. Whatever."

Keep dreaming! It would be totally impossible for you to comprehend anything an instructor told you.

"You're wrong. Period. Whine all you like. It doesn't change anything. I challenged you to call Humana and ask their collections department if they collect for providers."

Why would anyone here want to do that? In this ROR, Humana is collecting for themselves, from the author. Not from the provider.

"You refused, which means either you're too stubborn to admit that you lost this argument, you're to dumb to use the phone, or you can't push the buttons because your fingers are too fat. It's probably a combonation of the three."

What argument did I lose! I never thought or said that Humana collects from providers.

Too bad for you that they are collecting from a patient this time!

Your fat finger hit the key just next to the "i".

Keep on working your six figure job. Very soon you will be as wealthy as the senior citizens you complain about. However, you will have arrived at that point much sooner!

This is exactly what I was talking about, Andromeda.

So you want me to secure a document, from a company that I don't work for, stating services they DON'T provide, for every health care provider in America? Um, Ok, I'll get right on that. Pffft.

If you want to believe that Humana collects for providers, fine. If you want to doubt everything I say, fine. I tried to educate you, Forrest Gump. Oh yeah, I'm wrong. I guess my eight-year secondary education and Masters in this field was for nothing. I guess running a billing and coding department in a major Chicago hospital for twelve years makes you the expert over me. I guess they pay me nearly six figures a year for absolutely no reason. Whatever.

You're wrong. Period. Whine all you like. It doesn't change anything. I challenged you to call Humana and ask their collections department if they collect for providers. You refused, which means either you're too stubborn to admit that you lost this argument, you're to dumb to use the phone, or you can't push the buttons because your fingers are too fat. It's probably a combonation of the three.

"Again, the author is wrong about who the collections agency is collecting for."

Guess! Show us the paperwork the author got from Humana's collection agency and sent copies of to you. Use this paperwork to prove to us that Humana is not collecting from the author, and that he does not know what he is talking about. Deliver this time! Show us that you are not really mentally ill.

"They are collecting for the provider, not Humana. Many people think that Humana does this work for providers, but they don't. Show me a copy of a bill for a member liability on a claim specifically from Humana and I will hail your name without end on this website."

Don't ask me for it dummy. Ask the author! He has the information from the collection agency that Humana used to collect from him.

So, now the burden is on you idiot.

"I think I'd know what's going on here as it's the same job I've been performing for over twelve years."

You'd think so. That is why people here keep wondering why you show them no knowledge of anything related to health insurance or collection practices.

"You, on the other hand, have been working at nametag and hairnet jobs for twelve years or, more than likely, bleeding welfare payments from the government."

I suppose that would be like the disability payments you should be getting for your mental handicap.

"So you can 'wrong' all you like, but it doesn't change the fact that YOU are wrong and I am right."

Now I am sure that whatever caused your mental handicap also swelled up your head.

"Since you won't be able to send me a link like I asked,"

Show me again where you asked me for any kind of link!

"why don't you take my suggestion and call Humana and ask them to transfer you to the collections department. Then, ask the collections representative if they collect for providers."

Why would I want to do that? Humana hired a collection agency to collect from the patient, not the provider. You are so silly!

"I'm not doing your work for you anymore."

Show me what work you have done for me. If there was any, you get an 'F'.

Another stupid uneducated post "I am the law".

Whatever, Andromeda. I'm tired of trying to tell you what's going on with these medical billing and coding situations. No matter what I say, you'll just spit back some insane nonsense, so I'd appreciate it if you'd just devote your energy to improving your spelling and grammar.

Again, the author is wrong about who the collections agency is collecting for. They are collecting for the provider, not Humana. Many people think that Humana does this work for providers, but they don't. Show me a copy of a bill for a member liability on a claim specifically from Humana and I will hail your name without end on this website. So, now the burden is on you; send a link to a copy of this phantom document. Go ahead. But, I'll be waiting for a long time because this document does not exist and never will exist.

I think I'd know what's going on here as it's the same job I've been performing for over twelve years. You, on the other hand, have been working at nametag and hairnet jobs for twelve years or, more than likely, bleeding welfare payments from the government. So you can "wrong" all you like, but it doesn't change the fact that YOU are wrong and I am right. Since you won't be able to send me a link like I asked, why don't you take my suggestion and call Humana and ask them to transfer you to the collections department. Then, ask the collections representative if they collect for providers. You won't because it would just shatter your tiny ego to find out how wrong you are. Go ahead, call them anyway. They will tell you to your pimple-ridden face that they don't collect for them. I'm not doing your work for you anymore.

"Collections"

"Well, Andromeda, Heaven forbid the author be incorrect about who they think the collection agency represents."

Good try! The collection agency tells debtor what account they are collecting on. In this case Humana. Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"The collection agency is representing the provider."

Wrong! Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"Humana does not collect money from patients."

Wrong! Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"Humana does have a collections department that deals with employers that don't pay their premiums, too."

That doesn't apply here. Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"But, if there is some member liability such as a deductible or copay, that's between the provider and the patient."

That doesn't apply here. Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"Who do you think those billing people are sitting behind the desk at your doctor's office?"

They are sometimes sending statements to patients. So what? That doesn't apply here. Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"If you need further proof of that statement: At the hospital I work at, we have a collections staff of ten people attempting to collect debts from patients. If Humana was doing this work for us, what are those people doing there?"

This is perhaps your most stupid statement! That doesn't apply here. Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"Why don't you call Humana yourself and ask to speak to the collections department that specifically collects deductibles and copays from members? Let them confirm what I've been telling you. Their number is 800-448-6262."

Your statement does not apply here. This case does not involve "deductibles and copays from members". Read the post by the author again. Go up on the page as far as you can, then come down to where there is a name (Kent), and then read the material just above that name. 'DUH'.

"I believe the word you're looking for is 'DUH'."

That is the only sentence that you wrote that applies here. However, even that does not apply to this ROR. It only applies to you!

Congratulations. You wrote another useless 'smoke screen' post!

Well, Andromeda, Heaven forbid the author be incorrect about who they think the collection agency represents. The collection agency is representing the provider. Humana does not collect money from patients. The only exception to this is if the member has an individual policy not sponsored with an employer and the member doesn't pay their premiums. Humana does have a collections department that deals with employers that don't pay their premiums, too. But, if there is some member liability such as a deductible or copay, that's between the provider and the patient. Who do you think those billing people are sitting behind the desk at your doctor's office? If you need further proof of that statement: At the hospital I work at, we have a collections staff of ten people attempting to collect debts from patients. If Humana was doing this work for us, what are those people doing there? Why don't you call Humana yourself and ask to speak to the collections department that specifically collects deductibles and copays from members? Let them confirm what I've been telling you. Their number is 800-448-6262. I believe the word you're looking for is "DUH". Good luck.

Seriously, "I am the Law". You need to stop because you're making yourself look dumber and dumber.

How can you be so dumb, stupid and unable to read? I am surprised you can type and breath at the same time.
--------------------------
THIS IS FROM THE AUTHOR OF THIS ROR. IT IS LOCATED JUST ABOVE WHERE THE COMMENTS ARE LOCATED. LOOK FOR THE FIRST INFORMATION THAT HAS BEEN TYPED AT THE TOP OF THIS PAGE, JUST ABOVE THE NAME KENT:

"Now in December of 2008, Finance Systems of Green Bay, on behalf of Humana, has blemished a perfect credit record. Even after I told them this was a incorrect billing error on Humana's part." People at Humana were incompetent and now my credit report has been tarnished."
---------------------------
"When you said, 'Why would the provider care if Humana gets a collection agency to retrieve money from the author?'........"

"Why else would the provider attempt to bill the patient? Think about it: Humana doesn't collect money from patients, that's the job of the billing department in the provider's office. And Humana cares because that's customer service.""

Where in the universe did you come up with that? Explain the difference between these two statements:

1. Finance Systems of Green Bay(Humana chose this collection agency), ON BEHALF OF HUMANA, has blemished a(the authors) perfect credit record. Even after I(the author) told them this was a incorrect billing error on Humana's part." People at Humana were incompetent and now my(the authors) credit report has been tarnished."

2.HUMANA DOESN'T COLLECT MONEY FROM PATIENTS.

Show us that you can use correct logic this time, instead of starting with an untrue premise (that the provider is billing the patient). That is from LaLa land.

Good luck.

Seriously, Andromeda. You need to stop because you're making yourself look dumb.

When you said, "Why would the provider care if Humana gets a collection agency to retrieve money from the author?"........ Doesn't that tell you money was recouped from the provider for some reason? Why else would the provider attempt to bill the patient? Think about it: Humana doesn't collect money from patients, that's the job of the billing department in the provider's office. And Humana cares because that's customer service. That's Humana's job.

You continued to look like an A-1 lout when you said, "Think about what? The author said no one was notified by any means law or no law. 'Please think before you speak.' Give a reference or link to the federal law you referred to, and the exact section covering EOBs."........ I highly doubt that no EOB was sent out. Even on the off chance that that was the case, the member could've called or checked online. Humana isn't hiding claims information, obviously. As for giving reference stating where EOB's are a legality, nope, I'm not falling into that trap again. You'll just say I made up the information or spit back some other ridiculous nonsense. You obviously have the internet; look it up yourself assuming you can put down the industrial-sized bucket of KFC. Personally, I did a Google search for "insurance carriers must send an explanation of benefits." I realize that's common sense, but, hey, look who I'm talking to.

Finally you said, "To use your own words from ROR #333247:
'Have fun taking the short bus to your job at Wal-Mart, no wait, that's too fancy... Kmart.'" Well, all I have to say is, at least I can spell the word "bus".

"Is this a serious post?"

I don't know, you wrote that question in your own post

"Andromeda, why do you insist on butting in?"

Why do you insist in butting in? I have never seen you actually help anyone.

"Ok, I will grant you I wasn't PERSONALLY handling documentation at Humana for this member. I don't work for Humana. Yes, the EOB could've gotten lost in the mail or something like that. I'm sure that happens from time to time."

How do you know it was actually sent in order for it to "could've gotten lost in the mail or something like that"?

"I highly doubt Humana would just take back money from a provider 'because they want to'. That would inevitably cause their entire network of providers to disassociate themselves from Humana. Eventually, Humana would go out of business."

Show us where the author said; Humana took back money from a provider.

"Don't you think the provider would want to know why this money was being recouped? Even if the EOB never got to the member, the provider gets their own EOB and, even on the off chance that one never got to the provider, I'm sure they'd contact Humana directly. I do that sometimes in my job. It's also posted on their website."

Why would the provider care if Humana gets a collection agency to retrieve money from the author?

"Telling members and providers why a claim was adjusted is a FEDERAL LAW. I'm sure there is a good reason for this adjustment. Please think before you speak."

Think about what? The author said no one was notified by any means law or no law. "Please think before you speak." Give a reference or link to the federal law you referred to, and the exact section covering EOBs.

To use your own words from ROR #333247:
"Have fun taking the short bus to your job at Wal-Mart, no wait, that's too fancy... Kmart."

Andromeda, why do you insist on butting in?

Ok, I will grant you I wasn't PERSONALLY handling documentation at Humana for this member. I don't work for Humana. Yes, the EOB could've gotten lost in the mail or something like that. I'm sure that happens from time to time.

I highly doubt Humana would just take back money from a provider "because they want to". That would inevitably cause their entire network of providers to disassociate themselves from Humana. Eventually, Humana would go out of business.

Don't you think the provider would want to know why this money was being recouped? Even if the EOB never got to the member, the provider gets their own EOB and, even on the off chance that one never got to the provider, I'm sure they'd contact Humana directly. I do that sometimes in my job. It's also posted on their website.

Telling members and providers why a claim was adjusted is a FEDERAL LAW. I'm sure there is a good reason for this adjustment. Please think before you speak.

By the way, the word is spelled "bus", not "buss".

"I have to disagree with you when you say Humana never attempted to contact you or the dentist. Any time a claim pays, denies, gets adjusted, or gets retracted, a new explanation of benefits (an 'EOB') gets mailed out to the provider and to the member stating what happened. Legally, that has to be in writing."

So let's think about this:
Your words do not prove Humana sent an 'EOB' concerning withdrawal of benefits. You have no personal knowledge of what happened in this case. Once again, you are acting like an 'expert' and you have no knowledge to back you up.

"So let's think about this. First, the claim was paid. Then, it was retracted for some reason. If Humana never contacted the dentist (through an EOB), how would they know to re-bill you?"

Who are 'they'? It can't be Humana, since Humana didn't bill the author for the service in the first place and thus Humana couldn't have re-billed the author. It can't be the dentist, because he has been paid.

So now let's think about this:
Humana didn't need to know anything to re-bill. All they needed to do was to unilaterally 'decide' that they wanted the money back, and to send it to collection. That way they don't have to explain anything. From the authors description, this appears to be exactly the case.

Have fun taking the buss to Wally World.

Sounds like someone at Humana messed up. I think this problem could have been ironed out before this client's assets were damaged by this blunder.

If one could call to file a complaint, perhaps these problems can be resolved before more clients' assets are damaged in the future. If there is an incompetent employee or internal errors, they need to be reported, and action taken to maintain quality control.

Seems like it could do a better job, considering all the money it makes.

It is possible that the claim was corrected by the dentist; it doesn't necessarily have to be a company error. That happened with a surgery claim I had once.

This client's credit was damaged by a miscommunication. Humana paid the claim.

A year later, it wants its money back.

Seems kind of irresponsible for a fortune 500 company to not have it together enough to keep track of its own "EOB"s.

We can't complain, unless we file a written grievance to a PO box somewhere in Kentucky.

By that time, a collection agency is filing negative reports and harassing us on the phone.

Sounds like Humana screwed up, and the damage has been done. No complaints department. The client sees no alternative than to file on ripoff report.

Nobody is holding a gun to this person's head to have Humana. Unfortunately, having Humana has caused this client financial and credit damage which may take a while to repair.

Seems if the peeps at Humana had a phone number this person could call to complain, a lot of trouble would have been avoided.

Granted, I can't see why the claim was adjusted, so I won't comment there, but I have to disagree with you when you say Humana never attempted to contact you or the dentist. Any time a claim pays, denies, gets adjusted, or gets retracted, a new explanation of benefits (an "EOB") gets mailed out to the provider and to the member stating what happened. Legally, that has to be in writing. So let's think about this. First, the claim was paid. Then, it was retracted for some reason. If Humana never contacted the dentist (through an EOB), how would they know to rebill you? Answer: they wouldn't. Sorry, the dentist is either lying or uninformed.

I also think you're expecting to much of your insurance company saying that you want them to call every member and provider every time a claim gets worked. That'd literally be thousands of calls a day. It'd be impossible to make that many phone calls in such a short period of time. Besides, that's the purpose of those EOB's; to tell you what's going on with a submitted claim.