Complaint Review: Humana Gold Plus

Just because someone claims that their employees have specific training does not make it true. And if every employee has medical training, that does not prove their competency. Anyone can take a basic first aid class and claim to have medical training but that would not qualify them to the a surgeon. Even if they had completed medical school, would you trust someone who barely passed more than someone who has a license to practice medicine?

All medicines have a degree of risk involved. Even taking an over-the-counter drug, such as Tylenol, carries some risk. Normally, a doctor looks at the individual patient, their complete medical history, and makes a decision as to whether or not there is a risk with an individual drug. Does Humana's employees have the qualifications and the entire medical history of the patient to make a determination as to whether or not the risk of taking this drug outweighs the risks of not taking it?

As it is, at least where I am, a doctor takes into consideration the risks of prescribing a specific medication to a patient. In addition to this, the pharmacy also reviews the medications, and even compares them with other medications, to verify that there are no dangerous interactions.

Are we expected to believe that a Humana employee has the qualifications of either a Doctor (M.D. or D.O.) or a pharmacist? Do they have access to all of the necessary information?

Finally, who is the individual taking the risk? Does the doctor, pharmacist, or Humana employee take the medicine? Are they at risk if something happens? I do not believe so. It falls on the end user/consumer to take the medicine or not. If they are in severe pain or have disabling side effects, they may even be willing to risk their lives in the chance that it may improve their condition. What right does Humana have to step in and determine what this individual should do or not do?

First of all, Humana's claims reviewers are medically trained. If they feel that a drug is bad for you, trust me, they have the expertise to say so. Those claims go through multiple levels of review, so it's basically several people against your doctor. Ever think that maybe your doctor is in the wrong? No, of course not. It's just easier to point your little finger and scream about how evil a company is without researching the situation.
Second of all, you can't blame Humana if a doctor doesn't want to contract with them. What do you want them to do? Maybe bring in some armed thugs into the doctor's office and threaten the doctor with violence if they don't sign up? You're talking about letting the doctor make some choices, but you neglected to realize that it's their choice to do business with whatever insurance carriers that they want.
Third of all, if your provider didn't send the required information to Humana to get the perscription filled, why are you wondering why they denied it? Why don't you pick up your little phone and call Humana and do a three-way call with one of their reps and the doctor? That would certainly take less time than bad-mouthing a reputable company on the internet, wouldn't it?

I have finally been disenrolled from the Humana Gold Plus plan. Thank you Medicare for all your help. I hope no one ever signs up for Humana Gold Plus. All they do is lie to you.