Complaint Review: Humana Healthcare

Humana raised premiums 12% after "economic stimulus" to get more money. Humana CEO compensated $6.5 million in 2009. 

Ha ha ha!

You're funny, Franzg. I said prove that HUMANA got money from the government; not random figures for god knows how many other companies. Anyone could type in something like that. I see no mention of Humana at all. Trust me, I work for them and I think I'd know if Humana got a government bailout. Please work on your anger and lying.

Here is a breakdown of what managed care received from "stimulus package" to keep it from losing the premiums from the unemployed citizens it would have dumped- This comes from the bill Obama signed:

Um, Franzg, I don't know where you're getting your information, but Humana didn't receive any bailout. As for premiums being raised, I honestly can't say whether that happened or not, but if it did, I hope you realize that the troubled economy is causing everything to go up. Look at gas prices.

Franzg, I actually hope Obamacare DOES go through so you can see what will happen with your health care costs. Premiums will go up, payment to doctors will go down, and quality health care providers will simply stop practicing since they won't be able to get as much money. I can't believe you're actually wanting all competition for health insurance eliminated. Common sense tells you that competition the market for services helps control prices. If you or a provider feels that Humana isn't a good fit for you, go to United. Don't like United? Go to Blue Cross. Don't like Blue Cross? Go to Anthem. Etc. etc. etc.

So, Obamacare's monopoly will allow the goverment to charge whatever they want and pay providers whatever they want with NO ONE to compete with them. So, go ahead and support your dumb president's plan to screw up healthcare. If you think your premium is high now.....

FYI information, I'm typing these when I'm at home, not at work. Quit assuming.

Humana would have been in deep trouble when unemployment hit 10% due to inability to collect premiums. Part of the 2009 "economic stimulus" (what regular people call "the bailout"), was to pay the premiums that would have been lost due to unemployment.  To the tune of $25 billion.

Humana would have been in deep trouble when unemployment hit 10% due to inability to collect premiums. Part of the 2009 "economic stimulus" (what regular people call "the bailout"), was to pay the premiums that would have been lost due to unemployment.  To the tune of $25 billion.

I have no idea why this goof thinks Humana got a bailout.

Us regular human beings call it a "bailout", because it uses American taxpayer dollars to fund corporations like Chrysler, GM, and yes, managed care companies like Humana.

In order to prevent managed care companies like Humana from failing, the US treasury is spending approximately $25 billion to managed care to pay premiums for the recently unemployed clients of managed care companies including Humana.

And the OP's locale has no one stupid enough to accept Humana's crappy reimbursement.

Fine, Franzg.

Obviously, you're now officially living in a fantasy world.

You say Humana is accepting a bailout when they're not. I've proven otherwise. You say Humana is going bankrupt. I've proven otherwise. You say that Humana has no providers. That is dumb and I don't even need to prove that wrong. You say Humana doesn't pay any claims. I've proven otherwise.

So....

This is a symptom of a severe mental illness on your part. I refuse to argue anymore with someone with this condition. Please find a therapist to help you with your mental issues, because I'm tired of trying to educate you.

No one said "Humana has no "networks" or "members".

Many doctors don't accept Humana. OP's area devoid of fool doctors who accept crappy insurance.

Oh yeah, Humana doesn't have any networks or members. HA! They're the third largest health care insurance provider in America! That's like saying Microsoft doesn't sell software!

I'll walk you through it- Deep breaths, neck rolls, relax tour fingers and toes. Now think of your "happy place", and try to focus on positive thoughts.

It is a shame that many doctors are refusing to accept managed care plans. Doctors have to hire a team of skilled billing and collecting personnel just to keep up with managed care changes. The doctors also must put up with negotiating new rates, and prior authorization, carve outs, capitation, etc...

I think we are witnessing this trend because the doctors find it less expensive and less time consuming to accept cash, check, and credit cards, and then issue a receipt.

Humana should start simplifying the process of their business. It would help all involved. It could increase Humana's network. Then maybe doctors would be more willing to accept Humana, and more clients would be willing to buy it.

Let's break down Opana's last blog. (Opana is Franzg's alter-ego.)

"....I am a nurse case manager who deals with Humana insurance"

Congrats.

"...I am a nurse case manager in a hospital."

You've already mentioned that.

"...Humana is extremely difficult to work with on the provider (hospital) side on things. They do not provide patients in our area with an adquate choice of in network providers."

I don't know what area of the country you're talking about, but there is a possibly of a carrier not having a strong presence in a particular area. It has nothing to do with providers not wanting to contract with them.

"..Their prior authorzation process to obtain approval for their members to recieve 'speciality' is so cumbersome, I can so why patients and doctors just give up dealng with them."

Seriously, you're a case manager and you can't even formulate a sentence? Whew! Good luck to your clients! As for when my workers pre-cert things, they typically do it over the phone with no problem. The general number is 800-523-0023. (Assuming you know how to dial a phone.)

"...Then the patient gets stuck paying for the mediction out of pocket."

Check the patient's formulary first, genius. Carriers use ARGUS for Rx just like the pharmacy, so my advice is to learn ARGUS.

I am a nurse case manager in a hospital. Humana is extremely difficult to work with on the provider (hospital) side on things. They do not provide patients in our area with an adquate choice of in network providers. Probably because no one wants to contract with them. Their prior authorzation process to obtain approval for their members to recieve "speciality" is so cumbersome, I can so why patients and doctors just give up dealng with them. Then the patient gets stuck paying for the mediction out of pocket. Luckily, not all insurers are this way. So that's what makes it is easy to tell who's in for the big bucks profit and those insurers in it to break even.

The post states doctors in area do not accept Humana. Humana fails to pay them.

Sounds pretty straightforward to me.

A little bit more info would be nice.

I'm so sorry your so upset about this.

More and more doctors ARE refusing to accept these sleazy mis-managed care "policies". Regardless of how many of us are enrolled in managed care. (as if we had a choice).

We need a choice. If I actually had one, I would refuse to be enrolled with Humana.

As for working for managed care, you have got to be joking. Managed care is like the little tick turd our federal government approved of in 1993, and now can't get rid of. I would not even consider working for a company that spends more on its lobbyists than its clients.

Now go back to work, and start stenciling Humana on all the dumpsters in your region. Someone with a Humana plan may get pregnant soon.

More libel from Franzg this week.

He said, "More and more doctors continue to refuse Humana, and are also refusing to accept the bogus plans from other managed care corporations."

Humana is one of the biggest carriers in America. Humana signs up countless providers and members every year. Google it for more info.

Don't believe this guy. He doesn't know what he's talking about. He doesn't like Humana for some reason (I suspect he works for a rival company.)

Yes, I guess Humana's doing "great" right now.

Especially after receiving all that extra taxpayer money it gets to stay afloat.

More and more doctors continue to refuse Humana, and are also refusing to accept the bogus plans from other managed care corporations.

We need more options. These plans suck, and are too expensive and difficult to use.

Managed care is an oligopoly ruled by lobbyists and Wall Street banks. Now being funded by even more by taxpayer dollars than before the bailout. Its kind of scary.

Franzg said, "From our 2009 taxpayer funded economic stimulus package. The bailout money is given to Humana to extend coverage for the recently unemployed Humana clients. It is keeping Humana from going bankrupt."

Rebuttal: Ok, if he wants to live in La-La land and think Humana is having financial trouble, I guess I can't change his delusional mind. You'd think the fact that Humana just bought out the entire Order of Saint Francis hospital system would be enough proof, but oh well..

I've had numerous back and forth arguments with this person and just recently he said, "Now go back to work, and deny coverage for another cancer patient. And while you're at it, write an article on how generic tylenol is the best treatment for Alzheimer's disease."

Rebuttal: Franzg apparently doesn't know what a biller/coder's responsibilities are. I work for a hospital. Franzg knows this. Why would someone who works for the hospital have anything to do with denying a claim? Why would I write an article for a medical journal about Tylenol? (Notice the capitalized "T", by the way, Franzg. "Tylenol" is a proper name.)

From our 2009 taxpayer funded economic stimulus package. The bailout money is given to Humana to extend coverage for the recently unemployed Humana clients. It is keeping Humana from going bankrupt.

And yes, all the other managed care companies receive our taxpayer funded bailout money as well.

Go ahead and deny this until you are blue in the face. The money keeps flowing.

Why would I work for a managed care company? I think these companies are the epitome of fiscal irresponsibility and political corruption, rivaling oil companies and Ponzi schemes.

Now go back to work, and deny coverage for another cancer patient. And while you're at it, write an article on how generic tylenol is the best treatment for Alzheimer's disease.

Franzg keeps saying that Humana is receiving a bailout. This is absolutely 100% false. He is lying because he works for a rival company. Some other companies may be getting them, but not this one.

That's right folks.

Managed care corporations like Humana would go belly up if not for the 2009 taxpayer funded economic stimulus package. We are being taxed to keep managed care afloat.

I don't believe we need to move out of the country like "I am the flaw" suggests.

I just think our $640 billion a year should be spent a little more on healthcare, and less on corporate blunders and inefficiency. It is wasteful and inefficient to sell policies which have no providers in the area.

Sorry you think we all have to move out of the country. Some of us are just not as happy about deficits and recession as you are.

Franzg said, "I think it is downright totalitarianism to suggest that anyone who disagrees with something should move out of the country."

Rebuttal: I suggested moving to another country that better fits your political opinions, I didn't order you to do so. Suggesting is merely offering friendly advice.

Franzg also said, "I think the notion that Humana (a fortune 500 corporation currently floundering in the NYSE) would return a government sponsored bailout is downright delusional."

Rebuttal: Even if Humana was going to receive a bailout (which it's not, they are doing great financially), they would return that money. Lots of companies are doing that. Why? Look at GM, my man. Once you accept that money, you're on Uncle Sam's leash and he can order your company around like a hired servant. Thanks, but no thanks.

I don't know if the health insurance company that you work for is getting a bailout or not, but if they are, be prepared for the government to start horning in on their business.

I think it is "communistic" to pay part of my salary to a large corporation subsidized by my government to dictate how much and who gets paid for healthcare.

I think it is downright totalitarianism to suggest that anyone who disagrees with something should move out of the country.

I think the notion that Humana (a fortune 500 corporation currently floundering in the NYSE) would return a government sponsored bailout is downright delusional.

Enjoy your vacation. The rest of us will, I assure you. Just don't get sick, we have had enough complaints about Humana on ripoff report.

Whether you like it or not, the managed care companies have made a mess of things, and are currently on the congressional agenda for the next big infusion of tax dollars (aka 'bailout').

That MAY be true, but a lot of banks that got bailout money don't need it. Same thing here; If Humana does get any kind of bailout money; they won't use it or simply return it.

..Whether you like it or not, Wall Street and the banks is where Humana does its business. It is traded on the NYSE.

No kidding Mr. Forbes. It's a business.

If you believe that the only alternative to managed care is nationalized healthcare, then you should move out of the country. According to the statistics, you are getting third rate care here by comparison. Many people have already left the country because they can't get proper treatment here.

I don't advocate nationalized health care. What in the name of everything good and holy would make you think that? As for people leaving America for better health care; that comment is PARTIALLY true. A lot of restrictions on drugs and experimental procedures don't exist in other countries. Yes, people go to other countries to avoid those hangups imposed by the AMA and FDA. However, the providers in those countries don't accept American health insurance and demand full payment for procedures and drugs UP FRONT. Good luck paying that, my man.

..Being that 31 cents out of every healthcare dollar is taken by managed care companies, I believe I'm already being taxed enough, thankyouverymuch.

You're being taxed enough? Um, ok, obviously you don't know anything about health plans. Premiums for health insurance plans are deducted from your paycheck BEFORE TAXES ARE CALCULATED. Nice spacing on that comment, by the way.


..If Humana moved out of the country, it would undoubtedly lay waste to the economy and public health of that country as well.

Ha ha. I think you're going a bit overboard here. Laying waste to the economy? Destroying public health? Put down the apocalyptic science fiction novels, my man. You act like Humana controls the world. They're not Microsoft. There's plenty of other health insurance carriers out there.

..Being that 70% of individuals filing for bankruptcy for medical bills were INSURED, it may be time we look at an alternative to this behemoth. Medical insurance should not be correlated with bankruptcy.

Ok, that's close to being a real fact. It's actually 32%. Still, I'll agree, that's high. That's a case by case figure. Some people may have cheap, limited insurance through their employer, some people may have hit some sort of dollar limitation on their plan, some people may intentionally get services not covered by their policy. In other words, that figure can be generated by THOUSANDS of reasons not directly related to the actual carrier.


Well, I await your next otherworldly and near communistic rant so please, hurry up. I've got a vacation coming up and I need something to do.

Whether you like it or not, the managed care companies have made a mess of things, and are currently on the congressional agenda for the next big infusion of tax dollars (aka "bailout").

Whether you like it or not, Wall Street and the banks is where Humana does its business. It is traded on the NYSE.

If you believe that the only alternative to managed care is nationalized healthcare, then you should move out of the country. According to the statistics, you are getting third rate care here by comparison. Many people have already left the country because they can't get proper treatment here.

Being that 31 cents out of every healthcare dollar is taken by managed care companies, I believe I'm already being taxed enough, thankyouverymuch.

If Humana moved out of the country, it would undoubtedly lay waste to the economy and public health of that country as well.

Being that 70% of individuals filing for bankruptcy for medical bills were INSURED, it may be time we look at an alternative to this behemoth. Medical insurance should not be correlated with bankruptcy.

The "bailout" was for banks and Wall Street, genius.

Why move to Europe? They don't have managed care-

Are you suggesting that we all move out of the country if we don't agree with the managed care model?

Maybe you should run for dictator.

If you hate healthcare in America so much, Franzg, move out of the country then. Then you can get on ROR and whine about paying 50% taxes for third rate care.

Your ideas for healthcare are really stupid.

This person felt ripped off because they were being charged for an insurance policy that had no providers in the area.

Your response is that it is the doctors fault for being greedy, and if Humana does not withhold payments to them, we will all pay millions for a hangnail; managed care has nothing to do with it.

I think your response is lame. It is too bad healthcare in the US sucks so bad. I'm sorry managed care is spiraling down a Wall St. toilet. Blaming the provider is really stupid. We live in a supply-demand economy.

I blame the middleman. The physicians seem able to take care of themselves, and don't have complaints filed against them in ripoff report.

Your ideas for healthcare are really stupid.

This person felt ripped off because they were being charged for an insurance policy that had no providers in the area.

Your response is that it is the doctors fault for being greedy, and if Humana does not withhold payments to them, we will all pay millions for a hangnail; managed care has nothing to do with it.

I think your response is lame. It is too bad healthcare in the US sucks so bad. I'm sorry managed care is spiraling down a Wall St. toilet. Blaming the provider is really stupid. We live in a supply-demand economy.

I blame the middleman. The physicians seem able to take care of themselves, and don't have complaints filed against them in ripoff report.

Your ideas for healthcare are really stupid.

This person felt ripped off because they were being charged for an insurance policy that had no providers in the area.

Your response is that it is the doctors fault for being greedy, and if Humana does not withhold payments to them, we will all pay millions for a hangnail; managed care has nothing to do with it.

I think your response is lame. It is too bad healthcare in the US sucks so bad. I'm sorry managed care is spiraling down a Wall St. toilet. Blaming the provider is really stupid. We live in a supply-demand economy.

I blame the middleman. The physicians seem able to take care of themselves, and don't have complaints filed against them in ripoff report.

Your ideas for healthcare are really stupid.

This person felt ripped off because they were being charged for an insurance policy that had no providers in the area.

Your response is that it is the doctors fault for being greedy, and if Humana does not withhold payments to them, we will all pay millions for a hangnail; managed care has nothing to do with it.

I think your response is lame. It is too bad healthcare in the US sucks so bad. I'm sorry managed care is spiraling down a Wall St. toilet. Blaming the provider is really stupid. We live in a supply-demand economy.

I blame the middleman. The physicians seem able to take care of themselves, and don't have complaints filed against them in ripoff report.

Despite all of the soapbox politics going on here about managed care, I'll fill you in on what the real problem with healthcare is. The answer: providers are too greedy. Greedy, greedy, greedy. Granted, doctors are highly trained and highly educated and by rights, they should make good money, but their greed is what is driving up your health insurance premiums, not your carrier's discretion. (i.e., the more providers unjustly jack up their fees, the higher your premiums will go.)
The next time a provider files a claim with your carrier, you should get an explanation of benefits (an EOB) from whatever insurance company you're with. Assuming the provider is contracted with your carrier, what you'll want to pay attention to on the EOB is the "billed charges" versus the "allowed charges". The billed amount is what the provider wants to charge and the allowed charges are the contracted rate with your carrier. (You can't be balance billed for the difference, again, assuming the provider is contracted with the carrier.) What you're seeing there is an element of price control. This prevents providers from grossly overcharging for services making health care costs (for everyone) spiral out of control. If providers were given free reign over their fees, it would get to a point where no one can afford coverage at all. Your auto insurance carrier does the same thing when they want you to go to specific places to get your car fixed after an accident. I'm sure they have contracts with certain shops to prevent them from getting overcharged and thus, indirectly making your premiums rise.
People, I've seen doctors providers wanting to charge $2000 for removing a hangnail, $800 consultation fees to refill a medication, and over $900 in ambulance fees for a four block ride where no medical attention was given to the patient at all. (Literally, the patient walked into the back of the vehicle and sat there just like you were taking a taxi.) And before someone fires back saying "Well, you didn't know all of the specifics in those situations...", let me just tell you, in all three situtations, I was the patient. And in all three situations, the element of price control left me with just about $200 in member responsibility total between all three situations.
So Franzg, since your the champion of those (cough, cough) poor, starving, underpaid doctors, I suggest you join a doctor's lobby in Washington somewhere because no one is taking you seriously here.

I actually agree that I do not see a real ripoff. So what's the problem?

The problem is Humana has no complaints department. People are troubled, and come to this site for some help and/or some answers. These people feel "ripped off", so they come to this site.

Humana hires flamers to "stop the bleeding" in their spare time. The advice given by these hired flamers is to tell you it is all our fault for not reading the legal "certificate" properly. We are told that our employers are the problem. We are told our physicians are "too stupid" to file a claim properly. Humana refuses to open a complaints department.

Yes, I'm sorry, but the managed care contracts, a portion of which comes from medicare, is currently a commodity on the NYSE. I'm sorry about that.

I think that having all these silly contracts and lists of who and what a managed care company is willing to pay for is just stupid. Why can't the consumers use their paycheck withholding and annual deductible to actually shop around for our personal health needs? Why can the shareholders at Humana throw that money down a Wall Street sewer pipe for bonuses and golden parachutes, yet we can't go to our own physicians? The system is dysfunctional. To survive, a large corporation like Humana needs to raise our premiums, and cut our services, so that it can undercut any price offered by an intelligent alternative. Too Bad.

I'm just trying to tease out what is angering the consumer. Consumers would be better served to be able to cut out these middlemen. If we could personalize our coverage based on our needs, we would not be in a healthcare crisis. Ask the individuals who actually deliver the care what to do about payment. Physicians may not get decent reimbursement from managed care.

Ok, not trying to flame here, but I've been scratching my head trying to figure this out:

"Howabout a bailout"- Already covered in a previous post. The horse is officially dead, leave him alone.

"Thats what we can do about Humana's stock prices" - See above

"I guess I respectfully disagree that healthcare dollars (especially Medicare) should be traded publicly...When times are good, I get healthcare. When they are not so good 'there's nothing any of us can do'??????" - How exactly are your Medicare dollars being traded? And coverage determined by your plan would not be affected in any way by a stock price. Doesn't even make sense.

"The physician is liable whether managed care pays or not. The managed care company takes no responsibility for your health" - Liable for what? 'takes no responsibility'? What exactly are we supposed to be taking responsibility for? We can't determine who stays healthy and who gets sick.

"I think we are all asking 'Why do we need this dysfunctional system'. And the answer is that we are scared by the high cost of hospitalization" - Yep, and that's why you have insurance. Not sure how this point is relevant to Humana being a "RipOff".

"I say let the one who is liable get paid, and if ripped off, allow the consumer to sue. Why do we need Wall Street buying and selling your Irritable Bowel Syndrome? Nobody there cares if you get better anyway." - So by your logic mentioned earlier in the post, you want the consumers to sue the physicians? Pretty sure that happens. And people buy the stock betting the company knows how use the healthcare system, set up by our elected officials, in an efficient way.


Look if you really just want to blast Humana, I would suggest a blog. But if you're going to do it in a public forum with public viewers, you should probably have some facts to back up your claim.

Howabout a bailout!

Thats what we can do about Humana's stock prices.

I guess I respectfully disagree that healthcare dollars (especially Medicare) should be traded publicly, like coffee, chocolate and pork bellies. I don't see any need to have my hernia operation brokered on Wall Street. When times are good, I get healthcare. When they are not so good "there's nothing any of us can do"?????? There is something wrong with that.

The physician is liable whether managed care pays or not. The managed care company takes no responsibility for your health.

I think we are all asking "Why do we need this dysfunctional system". And the answer is that we are scared by the high cost of hospitalization.

I say let the one who is liable get paid, and if ripped off, allow the consumer to sue. Why do we need Wall Street buying and selling your Irritable Bowel Syndrome? Nobody there cares if you get better anyway.

Franz I couldn't agree more that healthcare in our country could be improved; but comparing ours to other "industrialized" nations are apples to oranges. Socialized healthcare in other nations works because of tax percentages that most here in the U.S. would find outrageous.

As for shining some light on Humana's expansion, all you have to do is look our member enrollment...up just as it should be. We are offering more products in more localities; that is the expansion in which I refer.

But implying that a company is going under or falsely claiming it has it's hand out for a government bailout is both false and negligent. I understand your frustration with healthcare, probably from a bad experience. We all have these types of experiences in any number of industries. But not every company that is successful is evil and planning a global or nationwide take-over.

As for our stock price, we are no different than any publicly traded company...when the market is down, it's down. Not much any of us can do about it. But please, if you're going to comment on a company, it should be based on facts; not on personal speculation at best.

Market share price Humana Feb. 2008- (less than 1 year ago) approx. $88
Market share price Humana Jan. 2009- approx. $30

Shine some light on the expansion

We are currently in an economic crisis. We all should agree on that.

I am saying we are also having a healthcare crisis. We are not perfect, and should never expect perfection. Unfortunately, we are stagnating, like a stinking pile of pond scum. Other industrialized nations seem to handle this better than we do.

With the current system, we have several choices. One would be to buy lots of heathcare stock to protect our investment in these managed care companies. Not all of us are willing and able to invest our hard earned dollars in the high risk environment of a flailing stock market.

The other option is to do your homework, and protect yourselves in the event of needing medical care. If you need complete coverage, an HMO or PPO may not be the answer. If you are young and healthy, it may work well for you.

I really only wish the managed care companies would be a little more clear about their rules and restrictions. Many paying clients may actually believe they are getting complete coverage. They do not understand the legalese of HMO, PPO, OON, capitation, usual and customary, etc... They may not understand that all their prescribed treatments are subject to review and denial of payment by their PPO. One may actually end up paying more for healthcare each year simply because they do not understand their coverage. It is often too complicated and frustrating. The rules change too often.

Many of the complaints on Ripoff report are attributed to clients not reading their certificate properly. We get frustrated when we are told it is our fault our treatment was denied. Most American consumers expect courteous and prompt customer service when we sacrifice a percentage of our salaries to a service corporation.

By the way, the automated computer system is a scary revelation about the current handling of my healthcare dollar.

Hey Guys,

I'm usually more of a lurker on this site, but I'll try to help out here. I work for Humana on the provider end of operations.

A majority of claims processes are automated, so any of us that use computers can tell you that sometimes things mess up. If the doctor in question is having a problem with a claim(s) paid, I would encourage them to call the provider customer service, their contractor (if it's a contracted practice) or their Provider Relations Rep.

If this is a case of a member with an HMO or PPO plan, then they could have gone out of network (OON). When you sign up for a plan you should ALWAYS check to see if your regular docs are in the network of providers; going OON is always going to cost the member more.

I have been working with providers for some time now, and atleast in my area we are quite reputable in terms of accuracy and speed of claims payment. Mistakes will happen though, and it's best to seek out as many avenues within the company as possible if you don't get an issue resolved with the first person you speak to.

I hope my info has been as helpful as possible with the limited info we have to work with. I know my opinion might be a bit biased, but it is my livelihood. Our company is like any other company and is not perfect. But if we suddenly became an AIG-type company, I must've missed the memo..and I'll be asking for a raise :)

Oh and just to clear up a couple things, Humana is nowhere near going under...on the contrary is actually expanding, has never once asked for a handout from our tax-dollars, and hasn't been in the hospital business for decades.

Hey Guys,

I'm usually more of a lurker on this site, but I'll try to help out here. I work for Humana on the provider end of operations.

A majority of claims processes are automated, so any of us that use computers can tell you that sometimes things mess up. If the doctor in question is having a problem with a claim(s) paid, I would encourage them to call the provider customer service, their contractor (if it's a contracted practice) or their Provider Relations Rep.

If this is a case of a member with an HMO or PPO plan, then they could have gone out of network (OON). When you sign up for a plan you should ALWAYS check to see if your regular docs are in the network of providers; going OON is always going to cost the member more.

I have been working with providers for some time now, and atleast in my area we are quite reputable in terms of accuracy and speed of claims payment. Mistakes will happen though, and it's best to seek out as many avenues within the company as possible if you don't get an issue resolved with the first person you speak to.

I hope my info has been as helpful as possible with the limited info we have to work with. I know my opinion might be a bit biased, but it is my livelihood. Our company is like any other company and is not perfect. But if we suddenly became an AIG-type company, I must've missed the memo..and I'll be asking for a raise :)

Oh and just to clear up a couple things, Humana is nowhere near going under...on the contrary is actually expanding, has never once asked for a handout from our tax-dollars, and hasn't been in the hospital business for decades.

Hey Guys,

I'm usually more of a lurker on this site, but I'll try to help out here. I work for Humana on the provider end of operations.

A majority of claims processes are automated, so any of us that use computers can tell you that sometimes things mess up. If the doctor in question is having a problem with a claim(s) paid, I would encourage them to call the provider customer service, their contractor (if it's a contracted practice) or their Provider Relations Rep.

If this is a case of a member with an HMO or PPO plan, then they could have gone out of network (OON). When you sign up for a plan you should ALWAYS check to see if your regular docs are in the network of providers; going OON is always going to cost the member more.

I have been working with providers for some time now, and atleast in my area we are quite reputable in terms of accuracy and speed of claims payment. Mistakes will happen though, and it's best to seek out as many avenues within the company as possible if you don't get an issue resolved with the first person you speak to.

I hope my info has been as helpful as possible with the limited info we have to work with. I know my opinion might be a bit biased, but it is my livelihood. Our company is like any other company and is not perfect. But if we suddenly became an AIG-type company, I must've missed the memo..and I'll be asking for a raise :)

Oh and just to clear up a couple things, Humana is nowhere near going under...on the contrary is actually expanding, has never once asked for a handout from our tax-dollars, and hasn't been in the hospital business for decades.

Hey Guys,

I'm usually more of a lurker on this site, but I'll try to help out here. I work for Humana on the provider end of operations.

A majority of claims processes are automated, so any of us that use computers can tell you that sometimes things mess up. If the doctor in question is having a problem with a claim(s) paid, I would encourage them to call the provider customer service, their contractor (if it's a contracted practice) or their Provider Relations Rep.

If this is a case of a member with an HMO or PPO plan, then they could have gone out of network (OON). When you sign up for a plan you should ALWAYS check to see if your regular docs are in the network of providers; going OON is always going to cost the member more.

I have been working with providers for some time now, and atleast in my area we are quite reputable in terms of accuracy and speed of claims payment. Mistakes will happen though, and it's best to seek out as many avenues within the company as possible if you don't get an issue resolved with the first person you speak to.

I hope my info has been as helpful as possible with the limited info we have to work with. I know my opinion might be a bit biased, but it is my livelihood. Our company is like any other company and is not perfect. But if we suddenly became an AIG-type company, I must've missed the memo..and I'll be asking for a raise :)

Oh and just to clear up a couple things, Humana is nowhere near going under...on the contrary is actually expanding, has never once asked for a handout from our tax-dollars, and hasn't been in the hospital business for decades.

It is a Fortune 500 company. It is an entity, not a person.

It also seems that in the near future we may be bailing Humana out with our taxes.

Why not just have our health care paid for? Why the need for a middleman? Why should it be funded by my taxes? And why should I have to bail it out?

When I look at my paycheck, it seems like I am already paying taxes for healthcare (medicare tax). It also looks like my taxes are about 35% of my income. I also believe the government subsidizes Humana (a Fortune 500 company) with these medicare taxes. So why do we suck compared to countries with "socialized" medicine?

It is the legislation that is wrong. Writing congress will not help (congress is influenced by Humana lobbyists). Congress and the POTUS wrote this legislation in 1993. Its a done deal.

We can do a lot better. Right now, we are throwing our money down the toilet with legislation like this. We are paying for "piece of mind" when we buy Humana. And from the looks of some of the complaints from the poor souls posting on Ripoff report, we are not getting any healthier when we buy Humana.

I'm not advocating that anyone not pay for "piece of mind" We are individuals with our own free will. I would advise everyone to prepare to pay out of pocket for healthcare whether they pay Humana or not. The entity named Humana is designed to deny and/or control our healthcare needs due to this legislation. Humana has a good chance of going belly up in our current cutthroat economy. Please protect yourselves.

It is a Fortune 500 company. It is an entity, not a person.

It also seems that in the near future we may be bailing Humana out with our taxes.

Why not just have our health care paid for? Why the need for a middleman? Why should it be funded by my taxes? And why should I have to bail it out?

When I look at my paycheck, it seems like I am already paying taxes for healthcare (medicare tax). It also looks like my taxes are about 35% of my income. I also believe the government subsidizes Humana (a Fortune 500 company) with these medicare taxes. So why do we suck compared to countries with "socialized" medicine?

It is the legislation that is wrong. Writing congress will not help (congress is influenced by Humana lobbyists). Congress and the POTUS wrote this legislation in 1993. Its a done deal.

We can do a lot better. Right now, we are throwing our money down the toilet with legislation like this. We are paying for "piece of mind" when we buy Humana. And from the looks of some of the complaints from the poor souls posting on Ripoff report, we are not getting any healthier when we buy Humana.

I'm not advocating that anyone not pay for "piece of mind" We are individuals with our own free will. I would advise everyone to prepare to pay out of pocket for healthcare whether they pay Humana or not. The entity named Humana is designed to deny and/or control our healthcare needs due to this legislation. Humana has a good chance of going belly up in our current cutthroat economy. Please protect yourselves.

It is a Fortune 500 company. It is an entity, not a person.

It also seems that in the near future we may be bailing Humana out with our taxes.

Why not just have our health care paid for? Why the need for a middleman? Why should it be funded by my taxes? And why should I have to bail it out?

When I look at my paycheck, it seems like I am already paying taxes for healthcare (medicare tax). It also looks like my taxes are about 35% of my income. I also believe the government subsidizes Humana (a Fortune 500 company) with these medicare taxes. So why do we suck compared to countries with "socialized" medicine?

It is the legislation that is wrong. Writing congress will not help (congress is influenced by Humana lobbyists). Congress and the POTUS wrote this legislation in 1993. Its a done deal.

We can do a lot better. Right now, we are throwing our money down the toilet with legislation like this. We are paying for "piece of mind" when we buy Humana. And from the looks of some of the complaints from the poor souls posting on Ripoff report, we are not getting any healthier when we buy Humana.

I'm not advocating that anyone not pay for "piece of mind" We are individuals with our own free will. I would advise everyone to prepare to pay out of pocket for healthcare whether they pay Humana or not. The entity named Humana is designed to deny and/or control our healthcare needs due to this legislation. Humana has a good chance of going belly up in our current cutthroat economy. Please protect yourselves.

It is a Fortune 500 company. It is an entity, not a person.

It also seems that in the near future we may be bailing Humana out with our taxes.

Why not just have our health care paid for? Why the need for a middleman? Why should it be funded by my taxes? And why should I have to bail it out?

When I look at my paycheck, it seems like I am already paying taxes for healthcare (medicare tax). It also looks like my taxes are about 35% of my income. I also believe the government subsidizes Humana (a Fortune 500 company) with these medicare taxes. So why do we suck compared to countries with "socialized" medicine?

It is the legislation that is wrong. Writing congress will not help (congress is influenced by Humana lobbyists). Congress and the POTUS wrote this legislation in 1993. Its a done deal.

We can do a lot better. Right now, we are throwing our money down the toilet with legislation like this. We are paying for "piece of mind" when we buy Humana. And from the looks of some of the complaints from the poor souls posting on Ripoff report, we are not getting any healthier when we buy Humana.

I'm not advocating that anyone not pay for "piece of mind" We are individuals with our own free will. I would advise everyone to prepare to pay out of pocket for healthcare whether they pay Humana or not. The entity named Humana is designed to deny and/or control our healthcare needs due to this legislation. Humana has a good chance of going belly up in our current cutthroat economy. Please protect yourselves.

Evil? That's kinda harsh language there, man. Consider it this way.. socialized health care... would you rather be in a situation where you MIGHT have to pay a $1000 deductible or possibly have to go out of network or pay 28% - 59% taxes that you will DEFINITELY have to pay? Seems like common sense to me. Why are you calling this company evil? If you don't like paying health care premiums and have an overpowering urge to gamble your financial future on not having insurance, by all means, don't sign up with them. No one's holding a gun to your head.

Yes, you are right.

Why pay more taxes for your healthcare? It's better to give your money to a Fortune 500 company listed on the NYSE. It is a free market economy.

I would advise everyone to also purchase stock in this Fortune 500 company. We are currently in a deepening recession, and decline in the market price means more service cuts. We may end up getting cataract surgeries at Walmart, and taking meds manufactured in China.

Protect yourselves from the evil taxes for healthcare.

If we allow Humana's market share price to decline, it may have to sell its hospitals and equipment. It may have to layoff or terminate its healthcare employees.

We may even have to bail Humana out with our taxes.

Yes, you are right.

Why pay more taxes for your healthcare? It's better to give your money to a Fortune 500 company listed on the NYSE. It is a free market economy.

I would advise everyone to also purchase stock in this Fortune 500 company. We are currently in a deepening recession, and decline in the market price means more service cuts. We may end up getting cataract surgeries at Walmart, and taking meds manufactured in China.

Protect yourselves from the evil taxes for healthcare.

If we allow Humana's market share price to decline, it may have to sell its hospitals and equipment. It may have to layoff or terminate its healthcare employees.

We may even have to bail Humana out with our taxes.

Yes, you are right.

Why pay more taxes for your healthcare? It's better to give your money to a Fortune 500 company listed on the NYSE. It is a free market economy.

I would advise everyone to also purchase stock in this Fortune 500 company. We are currently in a deepening recession, and decline in the market price means more service cuts. We may end up getting cataract surgeries at Walmart, and taking meds manufactured in China.

Protect yourselves from the evil taxes for healthcare.

If we allow Humana's market share price to decline, it may have to sell its hospitals and equipment. It may have to layoff or terminate its healthcare employees.

We may even have to bail Humana out with our taxes.

Yes, you are right.

Why pay more taxes for your healthcare? It's better to give your money to a Fortune 500 company listed on the NYSE. It is a free market economy.

I would advise everyone to also purchase stock in this Fortune 500 company. We are currently in a deepening recession, and decline in the market price means more service cuts. We may end up getting cataract surgeries at Walmart, and taking meds manufactured in China.

Protect yourselves from the evil taxes for healthcare.

If we allow Humana's market share price to decline, it may have to sell its hospitals and equipment. It may have to layoff or terminate its healthcare employees.

We may even have to bail Humana out with our taxes.

It sounds like you have a PPO. There is coverage for providers not contracted at Humana, but it's going to be at some sort of lower benefit. Now, before you spew venom at me, that benefit level is determined by the employer who sponsors the plan. You have to understand, YOUR EMPLOYER determines what's covered, to what extent, dollar and/or visit limitations, the networks used for their policies, what requires an authorization or what doesn't, and basically EVERYTHING about your policy including how much of the premium you as an employee are going to pay. Humana merely enforces the policy that they wrote.
Now in your rebuttal, you said "Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an 'out of network' provider." You act like Humana is trying to hide which doctors are contracted or not. Ever hear of calling Humana and asking them if your doctor is contracted? How about using their website? Why not order a provider directory? Right there, there's three ways you can find out that information. FACT: It is the patient's responsibility to determine the status of the provider. Don't give me that "No one told me" bit.
I agree healthcare isn't perfect, but you're acting like other countries have some magical solution to the issue. FACT: they don't. Take Sweden for example. Sure they don't have to pay anything when they need medical attention, but they also have 28%-59% taxes. Are you willing to pay that? Kind of puts your "huge monthly premiums" comment into perspective, doesn't it? Hey, if you've got a solution to the health care crisis, call your local Congressperson and give them the details.

It sounds like you have a PPO. There is coverage for providers not contracted at Humana, but it's going to be at some sort of lower benefit. Now, before you spew venom at me, that benefit level is determined by the employer who sponsors the plan. You have to understand, YOUR EMPLOYER determines what's covered, to what extent, dollar and/or visit limitations, the networks used for their policies, what requires an authorization or what doesn't, and basically EVERYTHING about your policy including how much of the premium you as an employee are going to pay. Humana merely enforces the policy that they wrote.
Now in your rebuttal, you said "Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an 'out of network' provider." You act like Humana is trying to hide which doctors are contracted or not. Ever hear of calling Humana and asking them if your doctor is contracted? How about using their website? Why not order a provider directory? Right there, there's three ways you can find out that information. FACT: It is the patient's responsibility to determine the status of the provider. Don't give me that "No one told me" bit.
I agree healthcare isn't perfect, but you're acting like other countries have some magical solution to the issue. FACT: they don't. Take Sweden for example. Sure they don't have to pay anything when they need medical attention, but they also have 28%-59% taxes. Are you willing to pay that? Kind of puts your "huge monthly premiums" comment into perspective, doesn't it? Hey, if you've got a solution to the health care crisis, call your local Congressperson and give them the details.

It sounds like you have a PPO. There is coverage for providers not contracted at Humana, but it's going to be at some sort of lower benefit. Now, before you spew venom at me, that benefit level is determined by the employer who sponsors the plan. You have to understand, YOUR EMPLOYER determines what's covered, to what extent, dollar and/or visit limitations, the networks used for their policies, what requires an authorization or what doesn't, and basically EVERYTHING about your policy including how much of the premium you as an employee are going to pay. Humana merely enforces the policy that they wrote.
Now in your rebuttal, you said "Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an 'out of network' provider." You act like Humana is trying to hide which doctors are contracted or not. Ever hear of calling Humana and asking them if your doctor is contracted? How about using their website? Why not order a provider directory? Right there, there's three ways you can find out that information. FACT: It is the patient's responsibility to determine the status of the provider. Don't give me that "No one told me" bit.
I agree healthcare isn't perfect, but you're acting like other countries have some magical solution to the issue. FACT: they don't. Take Sweden for example. Sure they don't have to pay anything when they need medical attention, but they also have 28%-59% taxes. Are you willing to pay that? Kind of puts your "huge monthly premiums" comment into perspective, doesn't it? Hey, if you've got a solution to the health care crisis, call your local Congressperson and give them the details.

It sounds like you have a PPO. There is coverage for providers not contracted at Humana, but it's going to be at some sort of lower benefit. Now, before you spew venom at me, that benefit level is determined by the employer who sponsors the plan. You have to understand, YOUR EMPLOYER determines what's covered, to what extent, dollar and/or visit limitations, the networks used for their policies, what requires an authorization or what doesn't, and basically EVERYTHING about your policy including how much of the premium you as an employee are going to pay. Humana merely enforces the policy that they wrote.
Now in your rebuttal, you said "Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an 'out of network' provider." You act like Humana is trying to hide which doctors are contracted or not. Ever hear of calling Humana and asking them if your doctor is contracted? How about using their website? Why not order a provider directory? Right there, there's three ways you can find out that information. FACT: It is the patient's responsibility to determine the status of the provider. Don't give me that "No one told me" bit.
I agree healthcare isn't perfect, but you're acting like other countries have some magical solution to the issue. FACT: they don't. Take Sweden for example. Sure they don't have to pay anything when they need medical attention, but they also have 28%-59% taxes. Are you willing to pay that? Kind of puts your "huge monthly premiums" comment into perspective, doesn't it? Hey, if you've got a solution to the health care crisis, call your local Congressperson and give them the details.

Why have "out of network" in the first place?

Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an "out of network" provider. Oh, you say you want a "network provider"? Too bad. You need another doctor.

By the way, more and more physicians refuse to accept Humana.

Corporations do not create conspiracy. People do. The corporation is merely a device to transform your money into shareholder profits. Humana is a very healthy corporation (Fortune 500) which has been very successful in increasing its point value in the Dow. It pays its bills on time. It makes sure their economic practices are legal and sound. By requiring prior authorization for payment only to network providers, it has much less worry about your claims. They were already denied in the prior authorization process if you went out of network.

Instead of "filling us in" after the fact, how about removing the legalese and insurance dogma and tell us the truth before we get reamed by huge monthly premiums.

We have the technology and wealth to lead the world in healthcare. Managed care is a virus which has infected our healthcare system, and has made it quite sick. We are lagging behind most other industrialized nations. You healthcare dollar should be pristine and untouched by the grubby hands of junk bond dealers.

Healthcare is a valuable resource in the United States, and using cheap medications and outdated therapies is good for the corporation's well being, but hazardous to your health.

Why have "out of network" in the first place?

Oh, I get it. If the client does not get an accurate list of providers when they sign up, then there is a greater chance they will seek treatment from an "out of network" provider. Oh, you say you want a "network provider"? Too bad. You need another doctor.

By the way, more and more physicians refuse to accept Humana.

Corporations do not create conspiracy. People do. The corporation is merely a device to transform your money into shareholder profits. Humana is a very healthy corporation (Fortune 500) which has been very successful in increasing its point value in the Dow. It pays its bills on time. It makes sure their economic practices are legal and sound. By requiring prior authorization for payment only to network providers, it has much less worry about your claims. They were already denied in the prior authorization process if you went out of network.

Instead of "filling us in" after the fact, how about removing the legalese and insurance dogma and tell us the truth before we get reamed by huge monthly premiums.

We have the technology and wealth to lead the world in healthcare. Managed care is a virus which has infected our healthcare system, and has made it quite sick. We are lagging behind most other industrialized nations. You healthcare dollar should be pristine and untouched by the grubby hands of junk bond dealers.

Healthcare is a valuable resource in the United States, and using cheap medications and outdated therapies is good for the corporation's well being, but hazardous to your health.

The "normal and customary" claim payments that you're talking about is only if a provider DOES NOT have a contract with Humana. (Other than that they pay based on the member's plan and the contract with the doctor; just like any insurance company.) After all, there's no sense in having a non contracted doctor thinking he or she could charge $14,000,000 for a simple office visit and thinking they're going to get that much. (This would indirectly raise your premiums if Humana did have to pay something like that to a non contracted doctor.) Nope, their going to get an average for that service in that geographic region. That average is defined by medicare standard, so it's not even a figure Humana determines.

It sounds like at some point you went to an out of network provider. I would avoid that if you can because, again, Humana can't control their pricing without a legal contract in place
.
Enough with the "big business conspiracy theories" already, trust me, there is no hidden agenda at Humana. My advice is to call Humana and ask them about what happens when a claim comes in to them and the provider is not contracted. I'm sure they'd be happy to fill you in.

Enron was also a Fortune 500 company before they were exposed.

Humana pays claims based on what they consider "normal and customary". It is decided by Humana number crunchers who are concerned about their corporate profits. They only pay a portion of the claim. They dictate what defines a claim. Often the bill submission is rejected as being "not covered" and "not medically necessary". They never become "claims" because Humana will not allow them to be. The goal of Humana is to continuously collect your premiums, and to reduce expenditures in any way possible to increase their share price on the NYSE. Its a giant money making machine which owns many hospital buildings, a giant central pharmacy, and most importantly, a highly paid team of accountants and lawyers. Doctors and clients are not organized enough to resist the power of this juggernaut.

In addition, a physician who is in network with Humana must jump through many hoops to get the proper care covered for their clients. A physician can only get reimbursed for procedures authorized by Humana. As a result, the physician is forced to administer cheaper procedures which are not as advanced or safe as our technology is capable of. The physician is also forced to initiate older, cheaper, and less effective prescription medications. Of course Humana and its team of administrators and lawyers ensures that this practice is legal. The physician is left with the liability of the outcome of these cheap, outdated practices.

That is why more and more physicians refuse to accept Humana insurance.

I think you mean to say that Humana doesn't pay claims. I find it hard to believe that a Fortune 500 Company doesn't pay their bills. Humana actually pays 99% of all claims submitted to them. They are #1 in payment of claims and have been awarded the J.D Powers award multiple times. So, these people who told you Humana doesn't pay claims are flat out lying.