Complaint Review: HUMANA Insurance

Since January or February 2015 I have been told repeatedly by Humana Insurance two things:

1) that my doctor "is in plan" then "out of plan", back and forth, since January 2015. Last time was June 29th, 2015, that he is IN PLAN and was given a billing code for the doctor's office to re-bill past bills for payment that had been refused by Humana and for current/future bills to be billed under for proper payment. I was assured this was correct and he was in-plan, so I was okay to go see him--just have office bill under the codes she gave me. As of Wednesday, July 29, 2015, one month to the day from previous contact, I am told he is out of plan and not payable under in-plan billing! So, there is another bill waiting in the wings for payment.

There are aparently no notes in their files as of today to support me; however, Wednesday, July 29th, there were! Where did notes on my file go--I do not know and they do not either. They printed his name on my insurance card and do not know why. Today I am told he left HUMANA in January 2015 and they (Humana) are not responsible to notify me. I now have two bills (plus one already paid) current one of $180 and one for about $190.

When I call to complain or inquire, I am put on hold and transferred. After 10-20 minutes on hold, I am cut off and have to call back, causing me to have to repeat everything I have just said and start over--all calls have lasted 3 1/2 - 4+ hours. There are no notes in their files to support this, just what the agent puts down.

2) if I go to CONCENTRA Urgent Care instead of Dr. office that is out of plan, I can be treated at no out of pocket cost to me! Yet, I just received a bill from Concentra showing $45 per visit totaling $180. It was dated July 20, 2015 and said I had 5 days to pay in full to avoid further action--received on the 30th of July, puts me out of their 5-day window.

Concentra says they billed correctly- problem is with Humana--Humana says billing should be re-submitted by Concentra as "Office Visit" so I have to call Concentra again. Concentra says my policy shows $45 cost per visit so they can not change it unless Humana corrects my policy......

Yesterday I was told by supervisor "Emily" she would call me back at 8am her time (5am Arizona time) with answers.

This morning I was waiting by the phone starting at 5am. At 7:30 am I received a call from "Jessica" saying my policy says Urgent Care is $45 so that is correct. She said she was investigating my claim. Says she "tried to call provider (doctor) to verify and they are closed--Do you mean this morning? Yes. Well they do not open till 8am--I just called them so they are closed--No, it is only 7:30 am here, so they do not open for another 30 minutes." Her repy was that doctor is out of plan so that is right on billing--sorry about whatever information I may have been told before. When I asked who I should call regarding complaint, she gave me 1-800-457-4708, and said to write complaint to: Attention: Grievance and Appeal with their address. The phone number she gave me: 1-800-457-4708, turns out to be Billing and Enrollment, who said she could not help me but gave me Mail Order Pharmacy phone number and transferred me to some one to help, who happened to be "Rob" who is also in Billing and Enrollment, but on the pharmacy side! He said he could help and when I gave him my information, he said he could not help because " all we handle here is pharmacy". I was so fed up I tod him I was going to Channel 3 News

I repeatedly tell them I am on Disability and need continuity of care, get an agreement from person, get transferred, and here we go again. I have trouble speaking, so these extended phone conversations are extremely difficult and painful for me. I hear nothing but negative comments regarding Humana in Flagstaff. Including "good luck with that--they do not care...  and no one else does either." Guess this is correct.  But I still need to be made whole with the costs of medical care that I have due their neglegence and "incorrect" or "incomplete" information.

PLEASE! No one seems to know what the other person/persons said/say and revert to scripted information. I am now in a credit problem, so I will have to pay another bill I have been told would not occur, and there is another one waiting!

Don't insurance companies have to follow through with what they say to patients? If they give "incorrect" or "incomplete" information ( I was told they don't lie, they just give incomplete information to patients by one of their staff during calls to Humana in February!) aren't they responsible for the extra financial cost to the patient? If there are note in file to support patient's claim, don't they have to follow through and pay those bills encurred from the "Incorrect" or false information? When a patient calls to verify doctor is still in plan, and is informed doctor is in pan, shouldn't the insurance honor the bill? Why can't an insurnace company the size of Humana get the correct information to its agents and on to its patients? Why cant an insurnace company the size of Humana transfer people correctly without extended hold times and cut-off calls? Why does Humana aparently NOT care about continuity of care for its patients? Why can I not just get a straight answer without someone falling back on a scripted phrase? Why can't I reach someone who cares even a little about their patients?

It would seem to me they could accept my bills from my doctor and pay as in-plan as they have repeatedly told me, and help me by paying Concentra Urgent Care bills they told me would be no cost to me! This really is a small amout to this insurance company, but more costly to me, someone on Disability and limited income.

Where do I go from here? Who will care enough to help me? I am at my wits end, and aparently can not get any medical care they tell me about. Thanks to the president's medical program, I have not been able to get out of this coverage and will not be able to get out until next January 2016. That's months paying for coverage I started under false pretenses.

I am concerned about retaliation from this insurance provider, but what can I do? I have to keep paying for coverage I now can not use.

Will you please help me?