Humana One sacm, ripoff, refusing to pay supposed COVERED office visits Detroit Michigan
In November 2006, I went ahead through ehealthinsurance, and decided to order a health insurance plan with Humana. After lenghty discussions with a rep, making sure I could go to a doctor if I was sick, that I had hospital coverage, etc. I was set. However, they wouldn't implement my policy until 30 days later. Ok, whatever. I paid the premiums, and my cards were mailed about mid December.
I made a doctors appt for January 4th and called Humana to make sure my policy was in effect. They assured me that it was, and that I was free to go to the doctor to get a checkup and physical without a PAP. So I went.
Yesterday I received notification in the mail that they had denied my doctors visit, the vaccine that I received, and the administration fee stating this: "Message 1: This service is not covered under your plan. Please refer to the limitations and exclusions portion of your benefit plan document."
So I went back through my contract and looked. According to the paperwork, I am able to have my doctors visit covered for a $35 co-pay and the vaccine should have been covered, as it was a necessity for my job.
I will be calling them on Monday to raise holy hell and will be filing a complaint with the State of Michigan and cancelling this pathetic policy. I have already paid $200 in premiums in 3 mos, and apparently they aren't willing to cover anything.
Beware if you choose this company to go with. They are crooks.
Amie
Grand Rapids, Michigan
U.S.A.
5 Updates & Rebuttals
I Am The Law
Cincinnati,Ohio,
U.S.A.
Response to Becki, Again
#6Consumer Suggestion
Fri, August 08, 2008
Becki,
I don't know why you feel obligated to attack me every time that I leave a posting on this site, so please stop. In response to my suggestion to this person, I've been doing medical coding for a hospital for over twelve years and I was just trying to leave a tip for Amie to help resolve the situation. Again for the fifth time, I do not work for Humana so please get the facts straight. Since you no longer work for Humana, I can only assume you got fired from there and your preferred tactic for venegence is to flame Humana on the internet.
Becki
Glendale,Arizona,
U.S.A.
Who is this "I AM LAW"?
#6UPDATE EX-employee responds
Wed, August 06, 2008
I am law,
Obviously you work in the B&E Dept. and your fortunate enough to not have seen any of the discrimination and crooked acts by this Company! Good for you, but you do not have the answers to everything, I mean come on! I understand that they are your bread and butter right now, and you're looking for "kudos" but do a little research on this place before you defend it the way you are! This place is absurd! Trust me I have experienced everything under the sun with this crooked employer!
I Am The Law
Cincinnati,Ohio,
U.S.A.
Here's why most likely
#6Consumer Comment
Thu, May 15, 2008
The diagnosis code probably reads "Other general medical examination for administrative purposes". "Administrative purposes" means that your insurance won't cover a medical exam for the sole purpose of traveling, getting a job, getting insurance, for a court appearance, etc. etc....basically, something other than a routine reason for getting the exam. That's pretty common in insurance. The medical code for that is V70.3. If it is, ask the provider to rebill using a different code if possible.
David
Seguin,Texas,
U.S.A.
You are not alone.
#6Consumer Comment
Tue, April 22, 2008
My company (over 1300 employees) had switched to Humana a few years ago. Some employees knew of friends and families that had used Humana. They were all saying how much of a bad thing this was. All of their friends and family members had problems with Humana.
Unfortunately, we had no choice. This was to be the new company insurance.
My doctor had not accepted Humana in the past and was not happy about the change. He told me 'they take forever to pay' He agreed to accept it because there were so many of his patients that work for my company.
My wife and I had constant problems with them. We had to fight with them on almost every claim. They did finally pay all but one, (My wife filed a Rip Off Report for it) but it is ridiculous, all the effort we had to go through to get what Humana owed us. It should have been simple.
My company usually changes insurances every 1-2 years to try to get the best rates for us. I have worked here 15 years, so we have had a LOT of insurance companies. I have NEVER had ANY problems with the others. They were all wonderful companies.
The company I have now has also been problem free. It is so nice to be rid of Humana.
It is sad that companies like this are allowed to thrive in this country.
There are so many crooked lawyers that defend them - there is little the consumer can do.
My company dropped Humana due to the large number of complaints to human resources. We pay slightly more for our new insurance but it is worth every dollar:)
I Am The Law
Cincinnati,Ohio,
U.S.A.
Read here.
#6UPDATE Employee
Thu, March 20, 2008
The diagnosis code on that claim is probably driving the denial. Ask your provider about it and then compare it to the exclusions and limitations section of the policy.