Complaint Review: Humana

It is a scam. It is not illegal. The one responsible for "verifying" that the doctor actually has a contract with Humana is the client.

Um, I didn't say that the Humana rep said ANY doctor had a contract with Humana. That is obviously illegal. You are lying. Please read the above post and again, if you feel something illegal was done, call the dept. of insurance so they can investigate it.

It is legal. Even your rebuttal states: "Also, yes, it is your responsibility as a member to verify providers you see and make sure they have a contract with Humana"

What you're describing is fraud Franzg. If you think Humana is doing this then contact the department of insurance. I assure you, we're not going to risk the integrity and financial well being of the company just to dork a member out of a few hundred dollars. When you contact the department of insurance, please post your case number here on this website, I'll be more than happy to cooperate with your investigation. Until then, please stop lying about my company. (Talk about propaganda.)

Yes, one year later, Humana still whining about anyone who complains about their policies.

This report is just stupid. Are you saying that Humana is routinely committing breach of contract by intentionally paying providers less than their contract? What a lie! That'd open the door for titanic amounts of lawsuits.

Also, yes, it is your responsibility as a member to verify providers you see and make sure they have a contract with Humana. I have no idea why members think all doctors in a facility have the exact same contracts with the exact same carriers.

Yes, the OP has verified Humana's practice of signing up physicians, then lowering the reimbursement rate. Then tells the doctor to collect excess from the client in the form of out of pocket fees.

Doctor then decides not to play this silly game with Humana, and declines to accept cheap Humana reimbursement.

Humana then still has doctor on "preferred list" much to dismay of the client.

That is what this complaint has exposed. Humana should stick to original agreement with doctor.

Final response to Franzg: Tired of arguing with you about common sense things.

Since insurance carriers have markets, just like any other business, then yes, you should choose a carrier that has a strong presence in your geographic region.

I noticed that the provider made no attempt to tell the member that they were having a rate dispute with Humana BEFORE the provider rendered services. That would've been nice of the dentist, huh?

You've been spotting?

I love how anyone that tries to explain something in defense of Humana is accused of being a hired blogger. Personally, I comment on blogs for US Bank, Humana, Best Buy, Geek Squad, Fifth Third, Sun Trust, AT&T, Wal-Mart, Target, and about ten others. Wow, if I'm getting paid by all those companies, I must be a millionaire!

Get over it, people. Not everyone is a bitter shut-in.

The hired bloggers at Humana like to flame and rip in those asking for help on this site.

The "rival insurance companies" need not worry about Humana. It has its own butt to protect, for it is managed care as well.

It will list physicians as "in network" and then later change its mind, just like Humana did.

We need options other than HMO and PPO. We need healthcare, not more forms to fill out. We don't need this $640 billion dollar mess anymore.

We should not have to check "every employee" at a clinic to see if they have sold out to Humana before getting our teeth cleaned.

I believe that if we had choices, we would be better off. Eliminate the buying and selling of our healthcare on Wall Street. Eliminate the red tape and "third party" system- (in managed care's case maybe we should include the Wall St. banks, the administrative doctors, and the taxpayer bailout, and call it a "sixth party system", since the all have their thumbs in the $640 billion pie).

We are being raped, and now told to "shut up".

Please be aware that an individual who calls himself Franzg routinely posts anti-Humana comments on this website. Please don't listen to him because he works for a rival insurance company.

Yeah, we are at fault, as well as our employers for considering Humana. No one is holding a gun to our head.

Buyer Beware, this corporation may suck. Read your certificate.

If you want to complain, you can mail it to a PO Box.

If you want to know your coverage now, read your certificate. Later, an automated computer will contradict the certificate, because your employer messed up for buying Humana, or your physician is "lazy" or you don't "know enough about health insurance".

You can send your grievances to a PO Box via snail mail.

Ok, obviously you don't know anything about insurance. You are indeed buying the policy when you allow payroll deductions to grant yourself the policy. The employer decides the policy particulars (who the carrier is, what's covered or not, copays, deductibles, etc. etc.) and you decide whether you want to sign up for it or not. Have you ever actually had a policy through your job before?

Dear I am not the law,

"4. Assuming that this is a commercial policy, YOUR EMPLOYER determines the particulars of the policy. What's covered, to what extent, what is excluded, copays, deductibles, premiums, and the network of providers is COMPLETELY 100% created by the employers. Humana just enforces the plan they wrote. If you want to blame someone for the member responsibility on a filed claim, blame the right people next time."

"If you don't like it; don't buy it."

"Look, unless you live in Massachusetts where you legally have to have health coverage, no one is holding a gun to your head to sign up with an insurance carrier. Certificates, again, are LEGAL CONTRACTS. There is no 'shuck and jive' maneuver that your health insurance carrier can do if you satisfy the requirements of the document. FINAL TIME: READ IT BEFORE YOU BUY IT!"

How do you "don't buy it" if "you don't like it" and/or "READ IT BEFORE YOU BUY IT!" when your employer determines what insurance he/she will buy "and the particulars of the policy"? The employee doesn't buy the policy dummy! The employer buys it for the employee. Think about it.

Look, unless you live in Massachusetts where you legally have to have health coverage, no one is holding a gun to your head to sign up with an insurance carrier. Certificates, again, are LEGAL CONTRACTS. There is no "shuck and jive" maneuver that your health insurance carrier can do if you satisfy the requirements of the document. FINAL TIME: READ IT BEFORE YOU BUY IT! I BET YOU READ A LOAN AGREEMENT BEFORE YOU SIGN IT, SO DO THE SAME THING HERE! Also, if you live in a state where a carrier doesn't have a huge presence, my advice: go with a carrier who does or else your benefits are probably going to be less if not zero based on the type of plan that you have. Is this hard? It's called the internet, people, use it or call the company directly for information about their dealings on a particular state. So, Franzg, you go right ahead and not get any health insurance coverage at all and then when you have an emergency and get something like a $50000.00 bill, we'll see who's laughing. I hope you enjoy bankruptcy.

You better read your flippin' certificate if you have Humana. You will then discover that you have NO COVERAGE at all for your ailment. No doctors, and no authorized treatment. You are the one who is wrong. It is not illegal to issue insurance in an area that has NO PROVIDERS ON THE PLAN!! It is legal YOU ARE WRONG!!

Gee, the certificate is so easy to understand, especially when you are doubled over in pain. Why are the victims on Ripoff Report told they are so wrong for suffering from medical conditions?

Do not listen to "I am the Law". Protect yourselves from managed care. Do your homework, there ARE alternatives. We have had enough of being treated like idiots when we are misled by a corporation which takes a monthly percentage of our pay.

The helpful response is to tell the victim of this atrocity to inquire about health plans that actually will pay for area physicians. The managed care company will withhold this from you. (See response from "I am the Law").

Why do the employees of Humana abuse their clients on ripoff report? It is because they are too scared to open a complaints department in their own corporate HQ.

I honestly don't know how many times I need to go through this, but, hey, I got a few minutes to kill.

1. Your certificate is a legal document. Read it before blasting your carrier on the web. I'm sure there's some deductible or copay.

2. It is the patient's responsibility to check to see if a provider has a contract with Humana and also that they will file a claim with the carrier. Humana can tell you who they have contracts with, but can't predict whether the provider will actually file a claim. Providers are basically stupid and can't or won't tell you that information.

3. If you have a question about a claim. Call Humana directly.

4. Assuming that this is a commercial policy, YOUR EMPLOYER determines the particulars of the policy. What's covered, to what extent, what is excluded, copays, deductibles, premiums, and the network of providers is COMPLETELY 100% created by the employers. Humana just enforces the plan they wrote. If you want to blame someone for the member responsibility on a filed claim, blame the right people next time.

5. Humana pays 99% of submitted claims. Call and ask them for proof if you want. They have also won the J. D. Powers and Asso. award for customer service so pointing your little finger at them and calling them "evil" is just silly.

6. As for you living in Raliegh, insurance carriers have markets just like any other business. After doing some research, no, Humana doesn't have a strong presence there, but it sounds like United does. So get a policy with them if that's the way you feel. I would basically equate this to finding a Food Lion grocery store in Cincinnati, Ohio. They're all over the southern states, but not in the northern states. That doesn't mean they're going out of business or something. Same concept applies here. I'm sure there are states that Humana has a strong presence but United doesn't. By the way, if you want to get a policy with another carrier, you might want to go with someone other than United, since they've had that nasty little federal investigation thingy. Read below. I copied and pasted this from CNN.

..."The commissioners began an investigation into United Healthcare's claims payment practice in 2004, spurred by a high volume of complaints. The state officials, who worked with the National Association of Insurance Commissioners, are requiring UH to agree to be evaluated by an independent monitor through 2010. Among other things, the monitor will look at whether UH pays claims on time and how it handles claim denials"...

7. Don't pay attention to Franzg. He is actually advocating not having health coverage at all. Granted managed care isn't perfect, but not having any coverage at all is totally irresponsible.

I've seen many reports like yours.

More and more physicians refuse to accept Humana insurance.

Please protect yourselves, and see the physician you trust, and that has a good reputation, and please inquire about the best way to pay for your care. Sometimes switching plans does not ensure long term healthy relationships with your trusted physician.

Make sure you are prepared to pay out of pocket if you use managed care. Quite often the coverage is inadequate, and clouded by unintelligible legalese and jargon. Just assume you are going to have to pay at least 50% of the bill to get good service.

Hopefully things will improve in the future. Good Luck.