Complaint Review: Humana - Lexington Kentucky

It has been three years. I don't remember the dates anymore.  The bottom line is this - Humana accepted the claim, told me a check is in the mail.  The check never arrived then they told me that too much time has passed. 

Thanks for the response (an actual employee)  but it is a few years too late.  I have had two more insurance companies since Humana and I have had no problems with either of them.  Out of 8-10 insurance companies I have had over the years, only Humana has been a problem.  Every claim was like pulling teeth. 


Thanks anyway.

You're funny Franzg. You comment on things you weren't even involved in. Oh, I forgot, you must know everything about Humana because you work there, too, right? If the author will be kind enough to give me their member number and the date of the call, I personally can listen to this tape. All you have to do is call me at 877-285-4630 and we'll listen to the call together. Sack up and dial the phone or are you afraid you'll be proven wrong, little boy?

Try reading before typing.

FYI Franzg I typed this when I was at home during nonwork hours. Don't be mean to me because the member didn't mention the reason for the shots when they called in.  As I suggested before, the member can demand that the call be reviewed to see what was said at the time. Also, no insurance company guarantees that a claim will be paid before they get it.

Quit butting in. You obviously have some anger issues. I'm trying to help this person. 

Read original post before spewing your BS, Humana employee. This client was lied to before- phone call won't help.

David, if you feel that the Humana rep lied to you, I'd suggest you call Humana out on it. Demand that the call be reviewed. All calls are recorded. Just to warn you, if you didn't clarify that the services were specifically for your admission to school during the initial call, you won't have a leg to stand on. After all, those types of services not being covered are clearly spelled out in black and white in your certificate of coverage.  

   Humana TOLD me IT IS ALL COVERED! Can't you read? Nothing else matters!  Do you not understand what a lie is?

   It does not matter what they policy says in writing.  A lot of that information is worded in such a way that it is not very clear or it is hard to understand.  That is why there is a phone number - so a person can call them and ask questions!  It is their job to know what they cover. 

   All they had to do was say "No, it is not covered!"  They did not.  THEY LIED TO ME!! Why is this so hard to understand?  If you tell someone something that is not true, IT IS A LIE!  Did your parents not teach you the difference between truth and lies?

As much as you all don't want to hear this, I am the law is totally right.

If that claim did have the V70.3 diagnosis, the claim will deny as not medically necessary. I am the law covered this in other posts quite well. Besides, I can't recall anyone ever dying or getting hurt from not going to nursing school. 

Members need to clarify the reason they're getting services so Humana reps can assist them. The member not telling the rep that these were for school caused this whole problem. It's time members step up to the plate and help us help you. 

Maybe that a drop in the bucket to a hot shot like you, but a simple denial by Humana, (submitted in writing, or would be "illegal" in your mind), would have been the proper procedure. No matter what your opinion of what "medical necessity" is. Client could get shots for less or for free. Clients without coverage are eligible for assistance for medications and care by organizations more humanitarian than "Inhumana". Humana has failed this client, and contributed to waste in the healthcare industry. This blunder should not go unnoticed.

Well, Franzg, I'm sorry you feel like Humana should pay for non-medically necessary services. I'm also sorry your hatred for Humana has dulled your common sense. I'm done with this argument. You know I'm right, but you can't admit it. Too bad. No more responses from me. You get your kicks from arguing and I'm not going to feed your sick fetish.

Press "I feel lucky" You will get the previous post. Colonoscopy at age 50 is covered by Humana. It is not a "life or death" situation. Just good clinical practice. Humana obviously needs to train its employees better. A simple denial on the telephone would have enabled this client to seek care elsewhere for less money (possibly for free). Really, really bad mistake by Humana,

Well, Franzg, I don't know what I was thinking when I thought you could answer a simple question without adding in your political comments and anti-Humana insults. So, let me do this for you. I asked, "Where the immunizations medically necessary AT THE TIME?" Answer: No, they were not. Not getting the immunization AT THE TIME would not have resulted in the death or bodily harm of the patient. Thus, the immunizations WERE NOT MEDICALLY NECESSARY AT THE TIME. The claim itself designated the services as for admission to a school only, NOT that they were medically needed at that point in time. Sounds like common sense to me. I'd imagine that you'd want insurance carriers to cover things like liposuction and cosmetic facelifts, too, huh? And you wonder why premiums are so high. It's for chumps like you and Tammy that expect carriers to cover NON-MEDICALLY NECESSARY expenses. Franzg, here's a little homework assignment for you. Humana has been named the easiest payer for medical providers to do business with in a review of 2008 claims payment data conducted by athenahealth, Inc. and Physician's Practice magazine. Why don't you Google that? As for this blog, you lost. You just can't admit it. You know I'm right, so save yourself the public humiliation and move on to something else. May I suggest a corporate conspiracy theory website?

No problem. Now turn on your interrogation lamp- 1. I think it is medically necessary to vaccinate ALL individuals against Hepatitis B. We have the technology. However, I do not think for one moment that the OP's policy considers this procedure medically necessary. I agree Humana does not cover vaccine for adult, except flu shot. 2. I am not 100% sure whether OP told rep shots were for school. I would definitely bet my life savings that the Humana employee was incompetent, and did not even ask. Poor customer service. Poorly educated employees. OP would have benefitted from denial in writing- could get shots at discount or for free if not covered by insurance. We pay managed care lots of money to service our healthcare insurance, and all we get is crummy service like this. It is truly a gyp, in the classic sense. People doing a really bad job, and it hurts the clients physically and financially. You need to do some relaxation exercises. I know Humana does not cover Hepatitis B vaccine. Too bad its own employees do not know that. "Grievance and appeal" would only yield "not medically necessary" response. Now tell me why we have to pay for this stupidity- isn't that what this forum is really about? Now answer the question!

Franzg, your argument is a lost cause. How many times do I need to mention the address for Humana Grievance and Appeals? I believe I'm on about time number ten with you. So enough with the "Humana should have a complaints department" statements. It makes you look dumb when you pretend like you don't read previous posts or your EOB's. Anyway, moving on. Answer two questions for me. No political banter, no anti-Humana comments, no "woulda, should, coulda" statements, just a simple yes or no. Can you handle that? Question 1: Do you believe that the immunizations were, by nature, medically necessary at the time? In other words, was the patient in a dire medical situation at that time? Question 2: Are you truly saying that you are 100% sure that when this person called Humana asking for benefits, she mentioned to the rep that these immunizations were specifically for attending school? Would you bet your life savings on saying that the author definitely clarified that fact during the first phone call? It's truth time, Franzg. Be a man and answer my questions truthfully. No more side-stepping the issue. Put your opinions about Humana and managed care aside for now. Yes or No? Which one is it?

The problem remains that Humana does not answer their phones, or have a complaints department. No suggestion box, no fax machine, no phone. Just a PO box to deny the claim as "not medically necessary". It will always end up that way after an incident like this. There is no way this customer will get any apology or relief for the incompetence of the employee. Nor will there be any corrective action or education given to the incompetent employee. Humana really needs to open a complaints department to handle its internal errors.

I don't know how many times I have to tell you idiots this. I guess if I put my rebuttal in all caps, you'll pay attention this time. THE MEMBER DIDN'T TELL THE REP THE IMMUNIZATIONS WERE FOR SCHOOL! IF THE AUTHOR WOULD HAVE CLARIFIED THIS, THE ANSWER FROM THE REP WOULD'VE BEEN CORRECT! THIS ISN'T HUMANA'S FAULT! IT'S IN PRINT IN THEIR POLICY THAT THIS ISN'T COVERED! (IN TWO DIFFERENT LOCATIONS!) THESE SERVICES ARE NOT MEDICALLY NECESSARY! WHY WOULD YOU EXPECT YOUR INSURANCE CARRIER TO COVER NON-MEDICALLY NECESSARY SERVICES? This is common sense! People, you lost this argument. Get over it! No matter how much you whine like babies on ROR, it doesn't change the fact that NO CARRIER ON THIS PLANET will cover non-medically necessary services! USE YOUR HEAD! Boo h*o. Wa wa wa. (I'm imitating you right now. HA!)

I don't know how many times I have to tell you idiots this. I guess if I put my rebuttal in all caps, you'll pay attention this time. THE MEMBER DIDN'T TELL THE REP THE IMMUNIZATIONS WERE FOR SCHOOL! IF THE AUTHOR WOULD HAVE CLARIFIED THIS, THE ANSWER FROM THE REP WOULD'VE BEEN CORRECT! THIS ISN'T HUMANA'S FAULT! IT'S IN PRINT IN THEIR POLICY THAT THIS ISN'T COVERED! (IN TWO DIFFERENT LOCATIONS!) THESE SERVICES ARE NOT MEDICALLY NECESSARY! WHY WOULD YOU EXPECT YOUR INSURANCE CARRIER TO COVER NON-MEDICALLY NECESSARY SERVICES? This is common sense! People, you lost this argument. Get over it! No matter how much you whine like babies on ROR, it doesn't change the fact that NO CARRIER ON THIS PLANET will cover non-medically necessary services! USE YOUR HEAD! Boo h*o. Wa wa wa. (I'm imitating you right now. HA!)

I don't know how many times I have to tell you idiots this. I guess if I put my rebuttal in all caps, you'll pay attention this time. THE MEMBER DIDN'T TELL THE REP THE IMMUNIZATIONS WERE FOR SCHOOL! IF THE AUTHOR WOULD HAVE CLARIFIED THIS, THE ANSWER FROM THE REP WOULD'VE BEEN CORRECT! THIS ISN'T HUMANA'S FAULT! IT'S IN PRINT IN THEIR POLICY THAT THIS ISN'T COVERED! (IN TWO DIFFERENT LOCATIONS!) THESE SERVICES ARE NOT MEDICALLY NECESSARY! WHY WOULD YOU EXPECT YOUR INSURANCE CARRIER TO COVER NON-MEDICALLY NECESSARY SERVICES? This is common sense! People, you lost this argument. Get over it! No matter how much you whine like babies on ROR, it doesn't change the fact that NO CARRIER ON THIS PLANET will cover non-medically necessary services! USE YOUR HEAD! Boo h*o. Wa wa wa. (I'm imitating you right now. HA!)

I don't know how many times I have to tell you idiots this. I guess if I put my rebuttal in all caps, you'll pay attention this time. THE MEMBER DIDN'T TELL THE REP THE IMMUNIZATIONS WERE FOR SCHOOL! IF THE AUTHOR WOULD HAVE CLARIFIED THIS, THE ANSWER FROM THE REP WOULD'VE BEEN CORRECT! THIS ISN'T HUMANA'S FAULT! IT'S IN PRINT IN THEIR POLICY THAT THIS ISN'T COVERED! (IN TWO DIFFERENT LOCATIONS!) THESE SERVICES ARE NOT MEDICALLY NECESSARY! WHY WOULD YOU EXPECT YOUR INSURANCE CARRIER TO COVER NON-MEDICALLY NECESSARY SERVICES? This is common sense! People, you lost this argument. Get over it! No matter how much you whine like babies on ROR, it doesn't change the fact that NO CARRIER ON THIS PLANET will cover non-medically necessary services! USE YOUR HEAD! Boo h*o. Wa wa wa. (I'm imitating you right now. HA!)

The representatives were misleading. I see all these long paragraphs of people defending Humana or opposing it, but nobody is getting the point. The author wouldn't be complaining if the facts were given straight and accurately. I know I've run into some of these problems in different aspects of my life and find that whether I am the customer or the representative, being misled is a hard thing to not be angry about. I bought my mother a purse for her birthday and was looking to return it today because she didn't like it. I wanted to exchange it for one that she would like. So she and I went to the store today and I asked the customer service rep. if I could exchange this purse for another. I had misplaced the receipt and couldn't run back home to find it, this is what I told her up front. She said without hesitation, "well, did you want to go and shop around for another then come back up for an exchange?" I said sure and she agreed and put the purse away and went on to deal with another customer. I came back about 30 minutes later (they had a lot of purses to look at) with my mother, who finally made a decision on what she wanted, and the same rep. told me "I'm sorry, on purses we can't do an exchange or refund without the receipt. I'm sorry I didn't know." So my mother had to purchase the purse with her own money (I didn't bring any on me because I assumed it was going to be a quick exchange) and I had to take the other. I of course went home to look for the receipt. I finally found it, had to go all the way back to the store in rainy weather, and proceed to return the purse and get the money and return it to my mother, since she is low on cash this week. I don't blame the rep. for misleading me and wasting my time (if I had known we would not have shopped around for 30 minutes for another purse, I would've left the store and find my receipt and come back another day), but I can't help but to be irritated that I had told her I didn't have my receipt, and she didn't have her facts straight and told me to go get another purse for an exchange she couldn't proceed with. It's human nature to be irritated, but I'm not saying it is worth having a fit over. I did what I had to do, made the extra efforts because of her misleading procedure, but the point here is that she made a mistake. This mistake caused me a bit of extra time, effort, and made me work around what I shouldn't have needed to in the first place; so, the big picture here is, being misled is not a good feeling. I don't care what the facts are whether Humana covers this or that, or doesn't cover prescriptions or whatever, the point is the author made the extra effort to ask whether these vaccinations were covered or not and the rep and supervisor both said yes and that is what is to be upset about. They said yes but really the answer is no. This has nothing to do with reading the fine print or understanding the policy. Fact is, they said something that wasn't true and it was their responsibility to either make sure their facts are straight first before talking, or at least follow up with an apology for their mistake. $300.00 gone without an apology or some sort of consolidation for the mistake is wrong. I own a restaurant, if I make a mistake and charge a customer full price and I forget to put in a dish, next time they come in I will replace the missing dish and on top of that give them a free order of something to make up for that mistake. I of course won't succumb to demands of a full refund simply because I made one mistake and tried to compensate for it, but I will apologize for my mistake and give what I owe. I think here the rep and supervisor the author spoke to owes an apology. They tried to offer a 90% refund but didn't do so at all which is wrong. To compensate for false advertising and false instructions they should at least give back a bit of money to make up for distress, not necessarily 90% but at least something. But there was nothing and that, aside from the misleading facts, is what's wrong here. Not reading some policy or understanding what is covered or not.

So Franzg, let's assume that for one second that author actually initially told the Humana rep specifically that the immunizations were the purposes of attending nursing school. (Although I'd bet good money she didn't.) FACT: The fact that immunizations for the purposes of attending an educational facility aren't covered is spelled out in plain English on her certificate. Two different people have posted this information in previous blogs. FACT: These are non-medically necessary immunizations. Can we agree on that? The limitations and exclusions portion of the certificate says that there is no coverage for non-medically necessary services. Even if she didn't bother to read up on her benefits, why on Earth would someone expect non-medically necessary services to be covered? Thus, even if the Humana rep underquoted or misquoted something, it's still in print on the certificate TWICE in seperate locations. AGAIN, THIS IS A LEGAL CONTRACT THAT THE MEMBER SIGNED OFF ON. Now, since you obviously weren't on the phone when the author was inquiring about benefits, you're commenting on something you don't know anything about. Won't you even admit that there is even a slight possibility that the author never initially clarified that the immunizations were for the purposes of attending school? Are you truly saying that there is NO possibility that the author failed to mention that info? Has your unfounded hatred of Humana blinded you that much?

But only after Humana employees are taught how to read. It would be also nice for Humana to remove their contradictory statements in the certificates. "Immunizations covered for adults" is pure bullcrap, and you know it. It is an abomination we have to put up with legal ripoffs like this. Humana is fleecing the American consumer in every way it can, and needs lawyers and lobbyists to keep it out of trouble because of its poor customer service. Humana really should try to get it together for once.

Franzg, seriously.... were you on the phone when the author called in? THE AUTHOR DIDN'T SAY THAT THE IMMUNIZATIONS WERE FOR NURSING SCHOOL. Get the point? NO INSURANCE COMPANY WILL COVER NON MEDICALLY NECESSARY SERVICES. Why would you expect them to? The member should learn to read their policy. You lost. Move on.

Customer service gave "proper advice" to get shots, because it is covered? They have no idea what questions to ask? If this is the fault of the client, then Humana is actually ripping off their clients on purpose. Please do not enroll with these scam artists. They give you false information, and it is all your fault for not understanding the contradictory coverage statement in the certificate.

Customer service gave "proper advice" to get shots, because it is covered? They have no idea what questions to ask? If this is the fault of the client, then Humana is actually ripping off their clients on purpose. Please do not enroll with these scam artists. They give you false information, and it is all your fault for not understanding the contradictory coverage statement in the certificate.

Customer service gave "proper advice" to get shots, because it is covered? They have no idea what questions to ask? If this is the fault of the client, then Humana is actually ripping off their clients on purpose. Please do not enroll with these scam artists. They give you false information, and it is all your fault for not understanding the contradictory coverage statement in the certificate.

Customer service gave "proper advice" to get shots, because it is covered? They have no idea what questions to ask? If this is the fault of the client, then Humana is actually ripping off their clients on purpose. Please do not enroll with these scam artists. They give you false information, and it is all your fault for not understanding the contradictory coverage statement in the certificate.

So, Theodore enters the ring... Well, Theo, the fact remains that the person calling into Humana neglected to tell the Humana rep that the immunizations were specifically for nursing school. I've established MANY times that policies don't cover services for NON-MEDICALLY NECESSARY reasons. (I'd like to this that that's common sense.) Why should your policy cover something that's not medically necessary? I have copied and pasted policy info directly from Humana's website MANY times saying that this isn't covered. In fact, some other person pasted information from their policy stating it wasn't a covered benefit. That's two people showing you the exact same information. Why do you continue to argue? It's in print, the member agreed to it by signing the enrollment information, case closed. Humana reps aren't mind readers, people. If the claim came in for something different than what you asked about, too bad, that's your fault. Whine all you like, it doesn't change the fact that Humana has the law (and common sense) on their side. The member signed a legal agreement saying that they had read and understand the terms of the agreement. Read it before you sign it next time.

The point is that Humana 1. said it was covered, 2. said it wasn't, 3. agreed it was and told that 90% would be paid, 4. never paid. Either persue any course of action available(and get things in writing) or get on with life. Btw, I have nothing against anyone here, but "I am the law", I'm curious, why didn't you know the difference between a Employee and a Consumer at the beginning of this report?

The point is that Humana 1. said it was covered, 2. said it wasn't, 3. agreed it was and told that 90% would be paid, 4. never paid. Either persue any course of action available(and get things in writing) or get on with life. Btw, I have nothing against anyone here, but "I am the law", I'm curious, why didn't you know the difference between a Employee and a Consumer at the beginning of this report?

The point is that Humana 1. said it was covered, 2. said it wasn't, 3. agreed it was and told that 90% would be paid, 4. never paid. Either persue any course of action available(and get things in writing) or get on with life. Btw, I have nothing against anyone here, but "I am the law", I'm curious, why didn't you know the difference between a Employee and a Consumer at the beginning of this report?

here is what the Diagnosis Code V 70.3 means: Other general medical examination for administrative purposes V70.3 is a specific code that can be used to specify a diagnosis V70.3 contains 41 index entries V70.3 also known as: General medical examination for: admission to old age home adoption camp driving license immigration and naturalization insurance certification marriage prison school admission sports competition V70.3 excludes: attendance for issue of medical certificates (V68.0) pre-employment screening (V70.5) I think this poor person was looking for help and you two are turning this into a personal ego battle between the two of you on who knows more. Health care systems are complex and constantly changing. You both seem intelligent, take that energy and channel into something good instead of being so spiteful!

Unless it is a flu shot. It is the Humana employee that cannot read.

Anyone who can't read the simple words in a certificate shouldn't be allowed to get medical coverage.Bottom line: The member asked 'Is this vaccination covered?' Response: 'Yes'. That response is correct based off of the information the rep was given. So, this is an obvious member error. The member should've asked 'Is this vaccination covered FOR THE PURPOSES OF ATTENDING NURSING SCHOOL.' No one misled the member. They just didn't fully inform the rep of the situation. WHAT IS IN PRINT IS LEGALLY THE TERMS OF THE CONTRACT. I pasted the limitations and exclusions section above multiple times; personal politics don't even come into play here. Humana did nothing wrong, illegal, or sneaky.

Humana employee told client to have shots, and pay out of pocket because it is covered. Please read original post. They did not expect to be denied coverage after trying to clarify it by calling Humana. I guess Humana should have just told the client that only a flu shot is covered by Humana. That would have been something we could all understand. There would not be a ripoff report about it.

How can you say that Humana applies benefits to "unsuspecting" people when it's clearly written how the benefits work in their certificate? I guess when you say "unsuspecting" you really mean lazy people who don't read their certificate.

The "certificate" covers a yearly flu shot. You still can't explain why Humana is unaware of what is printed on their own "certificates" it peddles to unsuspecting citizens. $640 billion a year is a lot to be spending on these worthless pieces of rubbish.

There you are again, Franzg. If you have a policy with Humana that isn't sponsored with an employer, YOU HAVE THE CERTIFICATE! Try reading it.

Humana does not cover routine adult immunization (except flu shot) I think a Humana employee, whom we pay with our premiums, should be aware of this. I guess you think it is not necessary for this giant corporation to know what the certificates that it peddles actually covers. Maybe you should try blasting other people than Humana clients. I happen to think the employee flailed by not giving accurate information to the client. You seem to think that they don't need to be informative on the phone. $640 billion shoveled out of our economy for healthcare, all being dumped into incompetent corporations like this? Humana can do better than that. The least it can do is understand what it sells us (to the tune of billions). That is why quality of care in the US ranks so low. Of course, you don't care about this. Just comment on the mysterious "certificate" which you advocate should be serviced by our employers (even if we are self or un employed)

Ok, Franzg, I tried to bite my tongue on this, but I'm in an argumentative mood, so prepare yourself..... You keep firing back with "the Humana rep lied" or "they withheld information" about the patient's benefits when they called in. My big question here is... Were you there? Were you on the phone listening to the conversation? I'm pretty confident in saying "No". Don't leave comments on ROR about things you can't verify. I've done my best to try to assist people here and all you do is offer conspiracy theories and goofy political commentaries that don't help anyone. So please, unless you were personally involved in any of these cases, please refrain from commenting on things you don't know anything about.

Joe, the humana.com website doesn't have any banner ads on it. I don't know where you were at but my advice is to always do business directly on the merchant's website. God only knows what kind of scam sites people have out there masquerading as a legit business.

IF YOU HAVE BEEN ON THE INTERNET ANY NUMBER OF TIMES, I DON'T HAVE TO TELL YOU WHAT AN AFFILIATE SITE IT. IT IS A RATHER DISHONEST WEBSITE THAT PROMISES YOU A GREAT PRIZE IF YOU WILL COMPLETE SO MANY OFFERS FROM THE ADVERTISERS WHO PAID TOP DOLLAR TO BE ON THAT SITE. SOME WHO DON'T REALLY WANT THE OFFERINGS FROM THE ADVERTISERS WILL COMPLETE THE FORMS JUST TO GET THE PRIZE -- ONLY TO FIND OUT THE PRIZE WAS NEVER OFFERED -- IT WAS JUST A BAIT AND SWITCH SCAM. THE ADVERTISERS ARE AFFILIATED WITH THE DISHONEST SITE AND THAT IS WHY IT IS CALLED AN AFFILIATE SITE. THEY SCAM YOU INTO GIVING UP YOUR INFORMATION BECAUSE THAT IS THE ONLY WAY MANY OF THEM WILL BE ABLE TO SELL THEIR GOODS AND SERVICES IS IF SOME PEOPLE THINK THEY CAN GET THE PRIZE BY SIGNING UP AND CANCELLING LATER. AS MANY RIP OFF REPORT POSTERS HAVE LEARNED, THIS IS NOT ALWAYS POSSIBLE. SO WHEN I SAW HUMANA INSURANCE HAWKED FROM SUCH A SITE, I KNEW SOMETHING WAS UP... AND NOW, ANYONE WHO READS THIS WILL LEARN ABOUT IT TOO.

IF YOU HAVE BEEN ON THE INTERNET ANY NUMBER OF TIMES, I DON'T HAVE TO TELL YOU WHAT AN AFFILIATE SITE IT. IT IS A RATHER DISHONEST WEBSITE THAT PROMISES YOU A GREAT PRIZE IF YOU WILL COMPLETE SO MANY OFFERS FROM THE ADVERTISERS WHO PAID TOP DOLLAR TO BE ON THAT SITE. SOME WHO DON'T REALLY WANT THE OFFERINGS FROM THE ADVERTISERS WILL COMPLETE THE FORMS JUST TO GET THE PRIZE -- ONLY TO FIND OUT THE PRIZE WAS NEVER OFFERED -- IT WAS JUST A BAIT AND SWITCH SCAM. THE ADVERTISERS ARE AFFILIATED WITH THE DISHONEST SITE AND THAT IS WHY IT IS CALLED AN AFFILIATE SITE. THEY SCAM YOU INTO GIVING UP YOUR INFORMATION BECAUSE THAT IS THE ONLY WAY MANY OF THEM WILL BE ABLE TO SELL THEIR GOODS AND SERVICES IS IF SOME PEOPLE THINK THEY CAN GET THE PRIZE BY SIGNING UP AND CANCELLING LATER. AS MANY RIP OFF REPORT POSTERS HAVE LEARNED, THIS IS NOT ALWAYS POSSIBLE. SO WHEN I SAW HUMANA INSURANCE HAWKED FROM SUCH A SITE, I KNEW SOMETHING WAS UP... AND NOW, ANYONE WHO READS THIS WILL LEARN ABOUT IT TOO.

IF YOU HAVE BEEN ON THE INTERNET ANY NUMBER OF TIMES, I DON'T HAVE TO TELL YOU WHAT AN AFFILIATE SITE IT. IT IS A RATHER DISHONEST WEBSITE THAT PROMISES YOU A GREAT PRIZE IF YOU WILL COMPLETE SO MANY OFFERS FROM THE ADVERTISERS WHO PAID TOP DOLLAR TO BE ON THAT SITE. SOME WHO DON'T REALLY WANT THE OFFERINGS FROM THE ADVERTISERS WILL COMPLETE THE FORMS JUST TO GET THE PRIZE -- ONLY TO FIND OUT THE PRIZE WAS NEVER OFFERED -- IT WAS JUST A BAIT AND SWITCH SCAM. THE ADVERTISERS ARE AFFILIATED WITH THE DISHONEST SITE AND THAT IS WHY IT IS CALLED AN AFFILIATE SITE. THEY SCAM YOU INTO GIVING UP YOUR INFORMATION BECAUSE THAT IS THE ONLY WAY MANY OF THEM WILL BE ABLE TO SELL THEIR GOODS AND SERVICES IS IF SOME PEOPLE THINK THEY CAN GET THE PRIZE BY SIGNING UP AND CANCELLING LATER. AS MANY RIP OFF REPORT POSTERS HAVE LEARNED, THIS IS NOT ALWAYS POSSIBLE. SO WHEN I SAW HUMANA INSURANCE HAWKED FROM SUCH A SITE, I KNEW SOMETHING WAS UP... AND NOW, ANYONE WHO READS THIS WILL LEARN ABOUT IT TOO.

IF YOU HAVE BEEN ON THE INTERNET ANY NUMBER OF TIMES, I DON'T HAVE TO TELL YOU WHAT AN AFFILIATE SITE IT. IT IS A RATHER DISHONEST WEBSITE THAT PROMISES YOU A GREAT PRIZE IF YOU WILL COMPLETE SO MANY OFFERS FROM THE ADVERTISERS WHO PAID TOP DOLLAR TO BE ON THAT SITE. SOME WHO DON'T REALLY WANT THE OFFERINGS FROM THE ADVERTISERS WILL COMPLETE THE FORMS JUST TO GET THE PRIZE -- ONLY TO FIND OUT THE PRIZE WAS NEVER OFFERED -- IT WAS JUST A BAIT AND SWITCH SCAM. THE ADVERTISERS ARE AFFILIATED WITH THE DISHONEST SITE AND THAT IS WHY IT IS CALLED AN AFFILIATE SITE. THEY SCAM YOU INTO GIVING UP YOUR INFORMATION BECAUSE THAT IS THE ONLY WAY MANY OF THEM WILL BE ABLE TO SELL THEIR GOODS AND SERVICES IS IF SOME PEOPLE THINK THEY CAN GET THE PRIZE BY SIGNING UP AND CANCELLING LATER. AS MANY RIP OFF REPORT POSTERS HAVE LEARNED, THIS IS NOT ALWAYS POSSIBLE. SO WHEN I SAW HUMANA INSURANCE HAWKED FROM SUCH A SITE, I KNEW SOMETHING WAS UP... AND NOW, ANYONE WHO READS THIS WILL LEARN ABOUT IT TOO.

Hepatitis B vaccine IS NOT COVERED unless you are without a liver. Please tell the folks at Humana to stop being idiots, and tell us the truth. Let's face it "I am the law", any moron knows Humana won't pay for a face lift. Thy don't pay for immunizations for adults either (except a flu shot). Unfortunately, this client was misled. The Humana employee was ignorant to the fact that Hepatitis B vaccines are not covered for adults, unless they need a liver transplant. I guess you don't give a flying hoot about Hepatitis B. Please stop wasting our time on Ripoff Report, and educate the Humana employees on how to answer a telephone. All this legal mumbo jumbo is really stupid. Humana misled the client on the telephone, and someone was charged for a vaccine after paying insurance premiums and now feels ripped off. I would too.

Ok, let's try this. Getting back to the diagnosis on the claim (not the services themselves)... if that diagnosis is V70.3....... (which I'm pretty sure it is..) General medical examination for: admission to old age home adoption camp driving license immigration and naturalization insurance certification marriage prison school admission sports competition .... that means that the immunzations are being given for a non-medically necessary REASON. In other words, the doctor may as well have written those exact words on the claim form! Would you not agree the above listed reasons are not medically dire? Insurance should only pay for things that are medically needed. Let's try another scenario. If a person gets cosmetic surgery just because they want to look younger, do you feel this should be covered? I would hope not because it's a waste of Humana's money and indirectly raises premiums for everyone. Now, if someone had to get cosmetic surgery due to a debilitating disease and couldn't walk because of that condition, that is a medically necessary reason. See the parallel here? Why should an insurance carrier waste money just so some chump can go to camp or go to college? Save that money for people with real medical issues. Paying that claim wouldn't be fair to me as a member, as again, this indirectly raises everyone's premiums.

I'm taking your advice, and I am continuing to read the above "certificate". Let's try to figure this out: 1. Newborn immunizations required by law- OK, that's pretty clear. Requires kids to get shots so they can attend school "required by law". Does not really apply to this adult requiring Hepatitis B vaccine to attend school. 2. Immunizations needed in response to an emergency or inpatient admit- ??????????????????? I guess you find this clear, but I do not. Maybe we should all get admitted to the hospital so we can get Hepatitis B vaccine. Or maybe call 911. 3. Immunizations in preparation for a surgery- This is the only scenario where I can find even a remote possibility of this client receiving a Hepatitis B vaccine. If the client needs a liver transplant, not caused by Hepatitis B, they would need Hepatitis B vaccine before the transplant. Humana would probably not insure anybody without a liver, so I doubt this would occur too often. 4. Female immunizations for the prevention of the HPV virus. (Gardisil)- Again, very noble, but has nothing to do with Hepatits B. Not unclear at all. 5. Routine immunizations during an adult annual physical- I still don't know what this means. I don't think this exists for age group 18-65. No Humana plan in my area specifies this coverage. However, if it did, the only thing I think it applies to is "flu shot" Point is, I had to think and surf the web for a while to understand this. Now that I think I have read and understood the certificate, I must ask why Humana employee told this client that the immunization was covered. They should have asked "are you a female newborn with no liver admitted to hospital after an emergency in need of HPV prevention who wants a flu shot?" I don't think it is too much to ask that the employees who are supposed to assist this client also read and understand the certificate, since no one is allowed to file verbal complaints to Humana.

Franzg, no matter what I say back to you in a blog, you'll just fire back with some childish "what if, woulda, shoulda, coulda" comment, so I'm not doing it anymore. You obviously have access to internet, so if you want information on what constitutes routine annual immunizations, do a Google search. In particular, reference the diagnosis code V70.3. Other than that tidbit, I'm not going to waste space here with information you can easily find yourself. You have been shown multiple times why this particular claim denied. It's in print. The member signed it. The member got services clearly not covered in the policy. Case closed. As for TMM33, I wouldn't tell you what hospital I worked at if God himself ordered me to do so. The last thing I need is some maniac stalking me and my family. But, what I will tell you is the same thing I've been telling my friend Franzg here. The member signed a legal document stating that they understand and agree to all terms of the policy. There's no sense screaming about it on ROR if you signed something and then the contract takes effect. It's your own fault. Case in point, I signed up with Geico about seven years ago for auto insurance. I didn't thoroughly read what I was signing and neglected to opt for collision coverage. I got into a minor accident in March 2007 which resulted in me having to pay $4300 for repairs to my own car. You don't see me blogging about how "evil" Geico is, now do you? It was my own fault I didn't read what I was signing and I got burned. I'm not saying no one should get medical attention, I'm merely saying know your policy and quit blaming companies when legal documents you signed are taking effect. If you don't like the terms of the agreement, don't sign it.

Why not write that this certificate covers: 1. Newborn immunizations required by law 2. Immunizations needed in response to an emergency or inpatient admit 3. Immunizations in preparation for a surgery 4. Female immunizations for the prevention of the HPV virus. (Gardisil) 5. Routine immunizations during an adult annual physical. That way Humana can inform the consumer they do not cover a Hepatits B vaccine (no scenario above would deem a hepatitis B vaccine as "medically necessary") Tell me about my routine annual immunizations (#5 on the list above). I bet there is no such thing. Hepatitis B will flourish long after Humana goes belly up. An immunization would help. This plan does not cover any hepatitis B immunizations. I guess scenario #2 would be necessary if you are unlucky enough to be insured by Humana healthcare.

Quote "I run a medical coding department for a major hospital and have done so for over twelve years. I'm pretty confident when I say that I know a lot more about insurance and billing than the average person. Just like in banking, most of the customer woes in insurance are self-inflicted. I'm sorry to sound so cruel, but it's a simple fact of people not investigating something before they jump into it." So what you are saying is that the insurance company and/billing department has a right to rip off people? If you do what you say you do, YOU would know that if I called you and wanted a breakdown of the costs, you would have to give that to me. Along with the insurance company. Since , we the CONSUMERS, keep you in your job you should know that. Trust me I have asked for it and got it. Although there were people like you telling me "I can't do that". Yes you can. Its quite frankly, I pay for something I want results. So how about we get off our high horse, MR. HighandMighty and stop trolling this site. I would love to know what hospital you work for because from what I see you are doing nothing but "harassing" someone who had a problem and wishes to express themselves. GOOD job Mr. 12 years. Only thing I am seeing is probably what your customers see. YES people who have to go do the Dr. believe it or not we are still the CONSUMER. Have a nice day.

Which you are a consumer. You can request a breakdown of your medical bill and/or insurance bill. A lot of insurance companies and/or doctors will push the envelope and try to charge you more than your supposed to be charged. Its common practice . Ask for a breakdown and have it sent to you. Call both humana and the doctor you went to. They have to give it to you.

Which you are a consumer. You can request a breakdown of your medical bill and/or insurance bill. A lot of insurance companies and/or doctors will push the envelope and try to charge you more than your supposed to be charged. Its common practice . Ask for a breakdown and have it sent to you. Call both humana and the doctor you went to. They have to give it to you.

Which you are a consumer. You can request a breakdown of your medical bill and/or insurance bill. A lot of insurance companies and/or doctors will push the envelope and try to charge you more than your supposed to be charged. Its common practice . Ask for a breakdown and have it sent to you. Call both humana and the doctor you went to. They have to give it to you.

Which you are a consumer. You can request a breakdown of your medical bill and/or insurance bill. A lot of insurance companies and/or doctors will push the envelope and try to charge you more than your supposed to be charged. Its common practice . Ask for a breakdown and have it sent to you. Call both humana and the doctor you went to. They have to give it to you.

Wow. That's quite a heated response, Franzg. Be cool, man. You said: "Immunizations are not covered by this 'certificate' Humana told the consumer immunizations are covered." Response: For the millionth time, immunizations are covered, but not for the purposes of attending school. It's in the certificate, it's been shown to you multiple times. You said: "It is cowardly, and hides behind the legalese of 'certificates'. And worse of all, it hires you to berate those it misleads. You suck as well." Response: Humana isn't hiding anything. That's the purpose of signed, legal contracts. Signing that document means that you acknowledge and agree to the terms of the contract. No if's, and's, or but's about it. Franzg, I don't work for Humana. If you don't believe me, oh well. I seriously doubt a company would hire someone to counter a measley twenty-five blogs on a website. By the way, thank you for telling me that I suck. That just means you care. You said: "If you think it is childish, why can't you come up with ANY scenario where one can get an immunization with this certificate." Response: Ok, here's a scenario. Better yet, here's a few: 1. Newborn immunizations required by law 2. Immunizations needed in response to an emergency or inpatient admit 3. Immunizations in preparation for a surgery 4. Female immunizations for the prevention of the HPV virus. (Gardisil) 5. Routine immunizations during an adult annual physical. There. There's five for you. There are obviously many, many more, but I'm sure you can find them online if you want. You have to know Franzg, I run a medical coding department for a major hospital and have done so for over twelve years. I'm pretty confident when I say that I know a lot more about insurance and billing than the average person. Just like in banking, most of the customer woes in insurance are self-inflicted. I'm sorry to sound so cruel, but it's a simple fact of people not investigating something before they jump into it.

Wow. That's quite a heated response, Franzg. Be cool, man. You said: "Immunizations are not covered by this 'certificate' Humana told the consumer immunizations are covered." Response: For the millionth time, immunizations are covered, but not for the purposes of attending school. It's in the certificate, it's been shown to you multiple times. You said: "It is cowardly, and hides behind the legalese of 'certificates'. And worse of all, it hires you to berate those it misleads. You suck as well." Response: Humana isn't hiding anything. That's the purpose of signed, legal contracts. Signing that document means that you acknowledge and agree to the terms of the contract. No if's, and's, or but's about it. Franzg, I don't work for Humana. If you don't believe me, oh well. I seriously doubt a company would hire someone to counter a measley twenty-five blogs on a website. By the way, thank you for telling me that I suck. That just means you care. You said: "If you think it is childish, why can't you come up with ANY scenario where one can get an immunization with this certificate." Response: Ok, here's a scenario. Better yet, here's a few: 1. Newborn immunizations required by law 2. Immunizations needed in response to an emergency or inpatient admit 3. Immunizations in preparation for a surgery 4. Female immunizations for the prevention of the HPV virus. (Gardisil) 5. Routine immunizations during an adult annual physical. There. There's five for you. There are obviously many, many more, but I'm sure you can find them online if you want. You have to know Franzg, I run a medical coding department for a major hospital and have done so for over twelve years. I'm pretty confident when I say that I know a lot more about insurance and billing than the average person. Just like in banking, most of the customer woes in insurance are self-inflicted. I'm sorry to sound so cruel, but it's a simple fact of people not investigating something before they jump into it.

Wow. That's quite a heated response, Franzg. Be cool, man. You said: "Immunizations are not covered by this 'certificate' Humana told the consumer immunizations are covered." Response: For the millionth time, immunizations are covered, but not for the purposes of attending school. It's in the certificate, it's been shown to you multiple times. You said: "It is cowardly, and hides behind the legalese of 'certificates'. And worse of all, it hires you to berate those it misleads. You suck as well." Response: Humana isn't hiding anything. That's the purpose of signed, legal contracts. Signing that document means that you acknowledge and agree to the terms of the contract. No if's, and's, or but's about it. Franzg, I don't work for Humana. If you don't believe me, oh well. I seriously doubt a company would hire someone to counter a measley twenty-five blogs on a website. By the way, thank you for telling me that I suck. That just means you care. You said: "If you think it is childish, why can't you come up with ANY scenario where one can get an immunization with this certificate." Response: Ok, here's a scenario. Better yet, here's a few: 1. Newborn immunizations required by law 2. Immunizations needed in response to an emergency or inpatient admit 3. Immunizations in preparation for a surgery 4. Female immunizations for the prevention of the HPV virus. (Gardisil) 5. Routine immunizations during an adult annual physical. There. There's five for you. There are obviously many, many more, but I'm sure you can find them online if you want. You have to know Franzg, I run a medical coding department for a major hospital and have done so for over twelve years. I'm pretty confident when I say that I know a lot more about insurance and billing than the average person. Just like in banking, most of the customer woes in insurance are self-inflicted. I'm sorry to sound so cruel, but it's a simple fact of people not investigating something before they jump into it.

Wow. That's quite a heated response, Franzg. Be cool, man. You said: "Immunizations are not covered by this 'certificate' Humana told the consumer immunizations are covered." Response: For the millionth time, immunizations are covered, but not for the purposes of attending school. It's in the certificate, it's been shown to you multiple times. You said: "It is cowardly, and hides behind the legalese of 'certificates'. And worse of all, it hires you to berate those it misleads. You suck as well." Response: Humana isn't hiding anything. That's the purpose of signed, legal contracts. Signing that document means that you acknowledge and agree to the terms of the contract. No if's, and's, or but's about it. Franzg, I don't work for Humana. If you don't believe me, oh well. I seriously doubt a company would hire someone to counter a measley twenty-five blogs on a website. By the way, thank you for telling me that I suck. That just means you care. You said: "If you think it is childish, why can't you come up with ANY scenario where one can get an immunization with this certificate." Response: Ok, here's a scenario. Better yet, here's a few: 1. Newborn immunizations required by law 2. Immunizations needed in response to an emergency or inpatient admit 3. Immunizations in preparation for a surgery 4. Female immunizations for the prevention of the HPV virus. (Gardisil) 5. Routine immunizations during an adult annual physical. There. There's five for you. There are obviously many, many more, but I'm sure you can find them online if you want. You have to know Franzg, I run a medical coding department for a major hospital and have done so for over twelve years. I'm pretty confident when I say that I know a lot more about insurance and billing than the average person. Just like in banking, most of the customer woes in insurance are self-inflicted. I'm sorry to sound so cruel, but it's a simple fact of people not investigating something before they jump into it.

Immunizations are not covered by this "certificate" Humana told the consumer immunizations are covered. They are not. Not under any circumstances. Humana sucks for lying to this consumer. It is greedy, greedy, greedy. It whines when it has to pay a claim. It is cowardly, and hides behind the legalese of "certificates". And worse of all, it hires you to berate those it misleads. You suck as well. If you think it is childish, why can't you come up with ANY scenario where one can get an immunization with this certificate. You can't, because you suck.

I have a friend who works at a bank. The stories he tells me absolutely shock me when it comes to people not reading what they're signing themselves up for. In one case, one customer asked why he had interest on his mortgage. Interest! Talk about not reading the contract! The same thing is going on here. A handful of Humana members aren't reading what they're signing up for and whining like little babies when the contract takes effect. Obviously with the paultry number of complaints on this website about Humana, many more people are reading the paperwork that they're signing. Franzg you can rant, rave, and preach your schizophrenic Michael Moore-ish politics until your blue in the face. The fact remains it was clearly stated in the documentation that the member SIGNED that immunizations are covered, but not for the purposes of attending school. Blogging back "Humana lied because immunizations aren't covered" makes you look childish. It's in print. Print is legal. The member signed it, but didn't read it. You lost this argument so can we just move to other blog to fight on?

That's right, just so it is clear... Humana will not cover any immunizations. I guess it thinks they are not medically necessary. Who knows how many others will be misled in this manner. When it comes to predatory managed care from Humana, I guess it IS comparable to all these great mortgage services we get from our lenders. That's a comforting thought. I also think it is laughable that you think the member is in error when they are told their plan covers immunizations. THEY ARE NOT COVERED. The Humana employee was in error.

Franzg said, "I'm sorry you think everyone is stupid for not understanding this. The Humana employee who misled this consumer did not understand it either." Anyone who can't read the simple words in a certificate is pretty much stupid. Bottom line: The member asked "Is this vaccination covered?" Response: "Yes". That response is correct based off of the information the rep was given. So, this is an obvious member error. The member should've asked "Is this vaccination covered FOR THE PURPOSES OF ATTENDING NURSING SCHOOL." No one misled the member. They just didn't fully inform the rep of the situation. PRINT, PRINT, PRINT, PRINT... WHAT IS IN PRINT IS LEGALLY THE TERMS OF THE CONTRACT. I pasted the limitations and exclusions section above; personal politics don't even come into play here. You lost. Humana did nothing wrong, illegal, or sneaky. I can't believe that people are so stubborn that they won't admit that they're wrong even when someone shows them what they signed up for. Laughable! God help these people if they ever sign up for a mortgage!

The original post states the consumer called customer service at Humana and was told that Hepatitis B immunization is covered. They misled the consumer. I still challenge anyone to come up with ANY scenario where one could get ANY immunizations with this plan. We are being misled into thinking that the policies we bought offer us coverage for immunizations, when in fact they do not. I'm sorry you think everyone is stupid for not understanding this. The Humana employee who misled this consumer did not understand it either.

Ok, Franzg, I can't decide if you're too stubborn to admit when you're wrong or just so lazy you won't scroll up to read Jake's blog, so I'll copy his post and paste it here for your review. Point six, CLEARLY says immunizations for that reason are not covered. Sorry, friend, you lose this argument. Your strange political opinions aside, you can not debate the fact that the carrier advised the member of this service not being covered and contract law is being applied. This is a legal document, after all. The Plan does not provide benefits for: 1. Services: a. Not furnished by a qualified practitioner or qualified treatment facility; b. Not authorized or prescribed by a qualified practitioner; c. Not covered by this Plan whether or not prescribed by a qualified practitioner; d. Which are not provided; e. For which no charge is made, or for which you would not be required to pay if you were not covered under this Plan unless charges are received from and reimbursable to the United States Government or any of its agencies as required by law; or f. Furnished by or payable under any plan or law through any government or any political subdivision (this does not include Medicare or Medicaid); g. Furnished for a military service connected sickness or bodily injury by or under an agreement with a department or agency of the United States Government, including the Department of Veterans Affairs; h. Performed in association with a service that is not covered under this Plan; i. Performed as a result of a complication arising from a service that is not covered under this Plan; 2. Routine vision examinations or testing; services to correct eye refractive disorders; radial keratotomy, refractive keratoplasy or any other surgery to correct myopia, hyperopia or stigmatic error; or, the purchase, fitting or repair of eyeglass frames and lenses or contact lenses, unless otherwise specified in the Plan; 3. Vision therapy (eye exercises to strengthen the muscles of the eye); 4. Routine hearing examinations; 5. Hearing aids, the fitting or repair of hearing aids or advice on their care; implantable hearing devices; 6. Routine physical examinations and related services for occupation, employment, school, sports, camp, travel, purchase of insurance or premarital tests or examinations, unless specifically provided under this Plan; 7. Immunizations required for foreign travel, unless otherwise specified in the Plan; 8. Elective medical or surgical abortion unless: a. The qualified practitioner certifies in writing that the pregnancy would endanger the life of the mother; or b. The pregnancy is a result of rape or incest; 9. Services related to gender change; 10. Services for a reversal of sterilization; Of course, I'm sure you'll comment back with some strange response, so I'll be waiting.

Thanks for verifying the obvious.Humana will not cover a Hepatitis B vaccine in ANY case. It is not covered under any circumstances. Why did they not write this in the "certificate"? Why did they tell this consumer immunizations are covered? Don't the people at Humana know what is covered? Should we be paying these freaks? I think not.

Seriously, are you two (Franzg and Andromeda) just that non-observant or are you just trying to pick an argument? The limitations and exclusions portion of the certificate is posted right there in Jake's post. (Scroll up, Einsteins.) In fact, Andromeda, you even thank him for posting it right below his report. So, that being the case, how is Humana hiding the fact that it's a non-covered service? Answer: they're not.

Why doesn't Humana just tell the truth, and inform its clients that immunizations are not covered? Tell me one example of anyone who would be able to be immunized for Hepatitis B with this "certificate". Just write "Hepatitis B Vaccine: Not Covered". It would avoid confusion.

I see you are still telling lies and ducking questions that you cannot possibly answer! I am not at all surprised, since you habitually make up 'facts' that you cannot ever prove. Here is your challenge Mr. minimum wage employee. Cut and paste the 'proof' out of the policy information posted earlier, and attempt to use it to disprove your reputation for guessing and/or lying.

"I am NOT the Law, Provide proof of the following two statements! 'FACT: It's in print that it wasn't a covered service.' 'FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof.' Good luck!" Prove what, Andromeda? You sound like a broken record. Look a few posts above this one at "Jake's" post. It's clearly spelled out there in writing that those services are not covered. (If you can't read it, ask an adult to help you.) That text is pasted directly from the man's certificate of coverage. There's your proof, sweetie. Did you grow up near a nuclear power plant or something? I suppose if God himself came down from Heaven and told you that you're wrong in this situation, you'd spit back the same goofy comment at him. You lost the argument, so just boo boo away and quit posting your insane rantings.

I am NOT the Law, Provide proof of the following two statements! "FACT: It's in print that it wasn't a covered service." "FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof." Good luck!

I am NOT the Law, Provide proof of the following two statements! "FACT: It's in print that it wasn't a covered service." "FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof." Good luck!

I am NOT the Law, Provide proof of the following two statements! "FACT: It's in print that it wasn't a covered service." "FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof." Good luck!

I am NOT the Law, Provide proof of the following two statements! "FACT: It's in print that it wasn't a covered service." "FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof." Good luck!

I've explained the situation a million times, Franzg. I don't know what else to say but the following: FACT: It's in print that it wasn't a covered service. FACT: Someone actually copied and pasted the limitations and exclusions section of their certificate on their report for proof. FACT: Humana did nothing wrong or illegal by denying that claim. FACT: It is the member's responsibility to read the policy before they buy it. All Humana members sign a legal document when they first get the policy that states that they have read and agree to all terms of the policy. If you take the time to read through a loan, lease, or mortgage document before you sign it, you should do the same here. FACT: No insurance carrier covers vaccines for the sole purpose of school, travel, employment, or for playing sports. FACT: Every inbound call to Humana is recorded. If the member is 100% positive that she asked the rep if vaccines FOR GOING TO NURSING SCHOOL are covered, then she can contact a lawyer to have the recording subpoenaed. After all, that would constitute a verbal contract if the rep did indeed promise that it would be a paid claim. My suspicions are that when she called in, she merely asked "Are vaccines covered?" and made no mention of needing them for attending nursing school. FACT: I noticed that the member didn't say anything about filing a written dispute with Humana. Most states have a 6 month statute (6 months past the processing date, to be specific) for filing a WRITTEN grievance with your carrier. If you go past that date, you're unfortunately out of luck. All explaination of benefits (EOB's) sent out by Humana have this information on it along with the address to file an appeal. Frankly, this whole argument is getting old. I'm sorry this claim got denied, but, alot of people have a nasty habit of not reading things before they sign them and then crying about it later. Take responsibility, America.

In this particular case, the victim would have saved thousands of $. In 1993, the US congress passed a bill allowing private health care companies (such as Humana) to issue stock and to become insurers of Medicare recipients. It was signed into law by the President of the United States. The vision of such health care corporations has now shifted. The goals of the corporations are to increase their market share price in the NYSE. It is inherent in the legislation. That is why a wealthy and technologically advanced country like the US ranks lower than most other advanced nations in delivery of quality healthcare. If the vision of Humana is to deliver quality healthcare, their vision would be to eradicate Hepatitis B off the face of this planet. Hepatitis B is a deadly virus (like polio and smallpox). Such vaccines are not administrative vaccines in my opinion. It is an issue of public health. Eradicating this virus with an effective vaccine seems like a very worthy cause. It can be done. We have the technology and the money. I say again, Humana is right. They clearly state in their contract that they do not cover "administrative vaccines". You can't fight Humana. They always win. You will never recover your money, or get quality healthcare. They have the "law" on their side. BTW, what is an administrative vaccine? In my opinion, it would be an injection that would keep creeps like "I am the law" from infecting and polluting a potentially helpful forum like ripoff report.

Again, read the certificate. It's a legal document. I guarantee it says that that particular service FOR THAT REASON (school) isn't covered. Tammy even said that the service was a hepatitis B vaccine FOR NURSING SCHOOL. Jake even posted part of his certificate stating that check-ups and/or injections for this reason AREN'T COVERED. I've never seen a policy that does. Why are you all giving such push back? You're wrong, I'm sorry. Read the proof. So, the carrier is upholding a legal document and suddenly they're the bad guy??? What's up with that? As for your catastrophic coverage example, let's say you cut your hand in a bizzare gardening accident and have to go to the ER. Definitely not "catastrophic". Removing a metal shard from hand (technically a minor outpatient surgery) $1000.00. Tetanus injection $200.00. Administration of injection $25.00. Supplies $25.00. Follow-up with doctor $400.00. Not having medical insurance when doing so could've brought $1950 bill this down to just being a mere $50 to $100 copay: priceless. Not having medical insurance coverage is flat out crazy. Sure, it might work out to your advantage in one isolated incident; that's not unheard of, but otherwise it's just irresponsible. 1/3 of all bankruptcies in America are due to medical bills. Look it up!

I'm sorry you think insurance companies don't lie. I guess they can do no wrong. Someone is paying $200+ per month for coverage. The victim then needs a hepatitis B vaccine in order to complete training in a facility which carries a risk of the victim being exposed to this deadly disease. The victim takes the trouble to call the insurance company (in this case Humana) to see if this service is covered. The insurance company replies "yes". The victim is then billed for the vaccine and is told by Humana that the service is not covered (bad diagnosis code)? The victim has now paid for the vaccine plus all the monthly premiums. The victim is understandably angry. They have been legally ripped off by an insurance company, and has paid premiums all year and cannot get their medical procedures covered. By the way, Hepatitis B vaccines are only effective if administered to individuals not infected with Hepatitis B, such as health care employees and students. Humana apparently "doesn't cover" this type of medical procedure. The best strategy is to ditch Humana, buy coverage for catastrophic events (like accident or cancer insurance), and pay out of pocket. This particular young victim would have saved thousands of $.

You're actually suggesting that someone cancel their insurance to SAVE money when they need medical attention? That is by far the dumbest statement I've ever heard. Go ahead and do it and when you get a bill for several thousand dollars for a simple procedure, we'll see who was right and who was wrong.

Nope, Humana didn't lie. The member didn't read their policy and won't accept responsibility for it. Someone even pasted their certificate information above and still you guys want to shift blame. That's the problem with this country; everyone wants to blame someone else.

The original poster was angry because she spent the time and effort to go through the painful process of getting her health care covered by Humana. It is upsetting to have to pay high insurance premiums as well as having to pay for health care out of pocket. It gets too expensive. Regardless of the diagnosis code, this victim was mislead by Humana that she was covered for vaccinations. Managed care companies often lie to the consumer so they don't have to pay the fee for the service. It is a game of attrition which the corporation always wins. The appeals process is painful, and there is no phone number to file complaints or grievances. Humana always has the upper hand. It seems that managed care companies should be able to find other ways of generating income besides abusing their customers. The best strategy is to stop paying premiums, and to pay out of pocket. It is cheaper, and will keep you alive, and out of the hospital. Hepatitis B is a deadly disease, and all should be vaccinated at no extra cost.

So, you're asking me if I have the information from this person's claim? Um, no... why would I have that? That's why I said it's PROBABLY the diagnosis code. Come on now...

I Am The Law, What spider hole did you crawl out of this time? "Sorry you feel that way, Arthur, but it doesn't change the fact that the diagnosis code is presenting the problem. Jake actually pasted part of his benefit document on here, so if you still aren't convinced that I'm right, that's your little problem." Prove it is the 'diagnosis code'. Where is all of your fancy research? Still can't find it again? Pure speculation again and absolutely useless to this thread. You are just a consumer like everybody else! Stop acting like a spokesman for Humana. You are giving Humana a bad name with your sarcastic and unhelpful attitude. Read the post above by Arthur. He can see right through you. If you still aren't convinced that he is right, that's your little problem. Arthur Wylie, Texas U.S.A.

I am sorry you feel you have had a bad experience with Humana. They are a good insurance company. From reading between the lines of your post, your small company must obviously be more concerned with saving money for themselves by changing insurance companies every year and to even think of dividing their insurnace in to a medical policy with one company and a prescription policy with another. That makes no sense other than them attempting to save money for themselves and not you the employee. Most prescription policies out there are discount plans. It is up to you, the consumer, to read your benefits booklet and understand what services are and are not covered. You calling and asking if something is covered can be submitted by the Dr under a totally different code or procedure causing it NOT to be covered. It also sounds like you might have some type of high deductible plan and that you over use it to begin with and again do not have a clue about what your policy even offers. And 100% of the Dr's out there that claim they want to stop taking Humana are because the negotiated rates they are paid are not as high as they want. It has nothing to do with the rate the claims are paid since they can be filed online rather quickly. It is all about how much more money they can put in their pockets. Please read your benefits booklet that you have to understand the type of plan you have. And understand, you get what you pay for. Your employer has bounced from company to company each year just looking for the cheapest rates, which include losing benefits for you.

Sorry you feel that way, Arthur, but it doesn't change the fact that the diagnosis code is presenting the problem. Jake actually pasted part of his benefit document on here, so if you still aren't convinced that I'm right, that's your little problem.

Sociopath: Little or no innate ability to separate truth from lies, right from wrong. Note to David and others trying to talk sense to this individual: There is no hope for someone who calls himself "The Law". Someone so out of touch with reality is not only a sociopath but shows psychopathic tendencies such as: Grandiose sense of self-worth Callous / lack of empathy Pathological lying I say "no hope" because a professional shrink knows better than to try to treat a psychopath. Any attempt to reach such an individual on an intellectual level will end in failure. Only incarceration can deter him and render him incapable of causing further harm to society. When researching Humana I learned to pass over without reading anything posted by this individual. I have learned also that not all complainants that appear on this site are without guilt, so I take the reports with a grain of salt. However in the case of Humana a company with this "person" as its spokesman, whether self-appointed or official, I have to conclude they are guilty of all these reports just by judging them by the company they keep. And if this "person" is self appointed, then I can only conclude that he and Humana deserve each other and his presence here in these discussions is a red flag that should not be ignored. Thanks to this report and others on this site I cancelled my appointment with their agent. I'll definitely be looking elsewhere.

Hi I also work for Humana and have been there several years. I have worked in the claims department and been a supervisor there. I have a great deal of claims experience. I have never seen this covered as well on any plan with Humana. But that doesn't mean you weren't told the wrong information. What I would do if I were you is call the Department Of Insurance if you have tried all of your appeals rights at Humana. Keep good track of all the dates you have called and mailed in information to them, who you spoke to etc. In this case it sounds as if you have not gotten any where with Humana at this time. Have you had a hearing with the medical director at Humana? If you have tried everything else you can call or write Humana and let them know you are going to contact the Department Of Insurance. When you do that they will take you serious. I hope this helps.

Thanks Jake. We have real documentation now. That would have answered a lot of questions in the beginning. A lot simpler than trying to find the 'Diagnosis code'. You are right though. The Authors' policy could have some differences. Good Work!

Thanks Jake. We have real documentation now. That would have answered a lot of questions in the beginning. A lot simpler than trying to find the 'Diagnosis code'. You are right though. The Authors' policy could have some differences. Good Work!

Thanks Jake. We have real documentation now. That would have answered a lot of questions in the beginning. A lot simpler than trying to find the 'Diagnosis code'. You are right though. The Authors' policy could have some differences. Good Work!

Thanks Jake. We have real documentation now. That would have answered a lot of questions in the beginning. A lot simpler than trying to find the 'Diagnosis code'. You are right though. The Authors' policy could have some differences. Good Work!

I found that info you were asking for in my policy Andromeda. Tammy's policy may be different, so I don't know if this is word for word in her information. I just copied the info from my online profile and pasted it below. Look at number 6. The Plan does not provide benefits for: 1. Services: a. Not furnished by a qualified practitioner or qualified treatment facility; b. Not authorized or prescribed by a qualified practitioner; c. Not covered by this Plan whether or not prescribed by a qualified practitioner; d. Which are not provided; e. For which no charge is made, or for which you would not be required to pay if you were not covered under this Plan unless charges are received from and reimbursable to the United States Government or any of its agencies as required by law; or f. Furnished by or payable under any plan or law through any government or any political subdivision (this does not include Medicare or Medicaid); g. Furnished for a military service connected sickness or bodily injury by or under an agreement with a department or agency of the United States Government, including the Department of Veterans Affairs; h. Performed in association with a service that is not covered under this Plan; i. Performed as a result of a complication arising from a service that is not covered under this Plan; 2. Routine vision examinations or testing; services to correct eye refractive disorders; radial keratotomy, refractive keratoplasy or any other surgery to correct myopia, hyperopia or stigmatic error; or, the purchase, fitting or repair of eyeglass frames and lenses or contact lenses, unless otherwise specified in the Plan; 3. Vision therapy (eye exercises to strengthen the muscles of the eye); 4. Routine hearing examinations; 5. Hearing aids, the fitting or repair of hearing aids or advice on their care; implantable hearing devices; 6. Routine physical examinations and related services for occupation, employment, school, sports, camp, travel, purchase of insurance or premarital tests or examinations, unless specifically provided under this Plan; 7. Immunizations required for foreign travel, unless otherwise specified in the Plan; 8. Elective medical or surgical abortion unless: a. The qualified practitioner certifies in writing that the pregnancy would endanger the life of the mother; or b. The pregnancy is a result of rape or incest; 9. Services related to gender change; 10. Services for a reversal of sterilization;

Jake, 'Not to take sdes or anything, but I think this law guy is right. I work for the City of Hamilton County in Ohio and Humana is our insurance carrier. I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter. Just puttin' in my two cents. I'm not trying to pick a fight or anything.' 'I think this law guy is right.' 'I think' just doesn't cut it. 'Law' has tried that through this whole thread. However, he COULD be right. You can settle this debate right now! 'I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter.' You finally have the power to finally help the author, since 'Law' has never been able to confirm anything with actual documents. You are a real asset to this thread. Quote the section that 'Law' got right. Word for word, from your documents, so that it can be verified it with a Humana agent. Do it quickly as 'Law' has used up much valuable time guessing, and the author needs the 'real help' that you can provide.

Not to take sdes or anything, but I think this law guy is right. I work for the City of Hamilton County in Ohio and Humana is our insurance carrier. I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter. Just puttin' in my two cents. I'm not trying to pick a fight or anything.

Not to take sdes or anything, but I think this law guy is right. I work for the City of Hamilton County in Ohio and Humana is our insurance carrier. I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter. Just puttin' in my two cents. I'm not trying to pick a fight or anything.

Not to take sdes or anything, but I think this law guy is right. I work for the City of Hamilton County in Ohio and Humana is our insurance carrier. I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter. Just puttin' in my two cents. I'm not trying to pick a fight or anything.

Not to take sdes or anything, but I think this law guy is right. I work for the City of Hamilton County in Ohio and Humana is our insurance carrier. I like to read every piece of paper that my employer gives me and that bit he wrote is pretty much word for word in our coverage letter. Just puttin' in my two cents. I'm not trying to pick a fight or anything.

Guys, seriously. It's not an issue whether vaccinations are covered or not. It's the diagnosis that isn't covered. (Vaccinations for SCHOOL, not general vaccinations.) Let me use an example. You can look at your policy and see that, let's say office visits, are covered 100%. But let's say that your employer decided that they didn't want to cover any claim involving infertility. If you go to an office visit for the reason of consulting with the doctor about infertility, the claim will deny. You just can't put every single diagnosis under a general benefit. That's why all policies have a limitations and exclusions section to them. Generally, vaccinations for employment, school, sports, travel, etc. etc. aren't covered. You just can't say ALL vaccinations should be covered without reading that section of the certificate. Again, I'm suspecting this is a V70.3 diagnosis code. I've pasted some info below for you so you can see what I'm talking about: V70.3 Other medical examination for administrative purposes General medical examination for: admission to old age home adoption camp driving license immigration and naturalization insurance certification marriage prison school admission sports competition Check with the doctor to see if they'll rebill it. I'm really trying to help.

The services themselves weren't denied, it was the reason for the vaccinations. I'm just trying to help.

'I am the law'. What is so hard for you to understand about 'my policy covers vaccinations'? All the rest of your posts here are misplaced, useless, irrelevant and miss the authors main point entirely. Use your head more! In this report You're an employee and an ex-employee. Give an excuse. I am the Law appears to me to have some credibility problems with his answers and where he has/currently works. See RipOffReport #354445, and decide for yourself. That report says he never worked at Humana, so I would take any Humana answers with a lot of suspicion. ALWAYS consider the source.

The diagnosis code is the problem. Refer to my above posts.

It's probably V70.3. Ask the provider.

1st of all do not listen to anything that this "law" character says, he's so unhappy in his life that he likes to get on here for the past FIVE months and belittle people, he's so insecure that this makes him feel inferior! I hope he feels like "Billy bad a*s" right now! Anyway, I however; did work for Humana, and this sounds very strange, because if the contract states that, it's a binding agreement, I'm not sure if you're a Medicare recipient or not but If so I'd call the canters for Medicare and Medicaid and let them know what has transpired, the # is 1-800-633-4887. What type of plan do you have? Is it a Supplement plan with a Deductible that has to met before they pick up any other costs? The reason I ask, is because I am not sure why they told you that you had to pay for it first and then they would re-imburse you, that doesn't make sense in itself. Did you by chance get anyone's name, because I have received lots of calls in which the person has received false information, and if they find they are at fault, they will reimburse you, (all calls are recorded) but you would need a name and approx date you spoke to them, and then I would call Billing and Enrollment at 1-866-992-2551 and let them know as well. I hope I could be of some help to you. I know it's very frusterating to go on here for help, and then get idiotic responses, from people who just want to let out some aggression on innocent people!

Andromeda, I can't be fired from a company I don't work for. You are right, though, I was guessing on the dianosis code. All I'm saying is is that particular code isn't covered by any carrier anywhere and that's the one most likely causing the issue. Again it's V70.3. Check it out on the web if you don't believe me.

I Am The Law, I see Humana finally fired you. You are just a consumer like everybody else now. What a relief! Now you can't give Humana a bad name with your sarcastic and unhelpful attitude. 'It's the diagnosis code. I'd bet good money it's V70.3. Again, not a covered diagnosis.' Pure speculation and absolutely useless to this thread.

It's the diagnosis code. I'd bet good money it's V70.3. Again, not a covered diagnosis.

The issue really is not that it was denied initially. That is just where the problem started. They denied is because it had to be prescribed by a doctor since the doctor did not have the vaccine in the office. After I went through the dispute process, the review board decided that is what a medical procedure and would pay 90%. This is not what the policy states, it should be 100% for all vaccines, but this is better than nothing. They told me they will send a check. The check did not arrive so I called again. The response was "The check is still processing." I called a few more times with the same response until my company dropped Humana for a better company. Now their response is "You are no longer with Humana so we owe you nothing." I should not have trusted them when they said I had to pay upfront. Never again. It is just not worth hiring a lawyer for $300. I am afraid I will spend much more than that. I don't know if I can sue for lawyer fees also.

"It's obvious It's obvious that you don't want to listen to reason. Fine, I'll quit responding to your story, but I just think you'd be better off if you'd pick up your little phone and try to work something out with the company directly. But no, I guess it's easier for you to point your little finger at the company and whine about how 'evil' it is. If you spent half the energy on communication with Humana instead of making false accusations, you'd probably have solved the situation by now. But let me leave you with one final thought: If Humana denied something that was allegedly covered in your plan 'just to do it', that would make that company guilty of insurance fraud. If that happened to enough people, we're talking about class action lawsuits and federal investigations. I don't see any investigators beating down the door. Oh well, I guess some people are stubborn." You are FAR from the voice of reason. As I have already stated, I have called over and over and over and over and over. They keep blowing me off. They tell me one thing and never follow through. They listen about as well a you do. Yes, I guess they are guilty of insurance fraud. And yes, YOU are stubborn. Also, why are you claiming to be an employee when you no longer work for them? Why does an actual Humana Employee respond? Tell me me this, slick.

"By the way. Research shows that Humana pays for 99% of the claims submitted. Compare that to other carriers, slick." I don't care what so called BS "reasearch" you are quoting. Sure they may pay MOST of the claims eventually. This does not show how much effort people have to go through to fight with them to get them to pay. Almost every claim! Again - READ what I wrote.

"By the way. Research shows that Humana pays for 99% of the claims submitted. Compare that to other carriers, slick." I don't care what so called BS "reasearch" you are quoting. Sure they may pay MOST of the claims eventually. This does not show how much effort people have to go through to fight with them to get them to pay. Almost every claim! Again - READ what I wrote.

"By the way. Research shows that Humana pays for 99% of the claims submitted. Compare that to other carriers, slick." I don't care what so called BS "reasearch" you are quoting. Sure they may pay MOST of the claims eventually. This does not show how much effort people have to go through to fight with them to get them to pay. Almost every claim! Again - READ what I wrote.

"By the way. Research shows that Humana pays for 99% of the claims submitted. Compare that to other carriers, slick." I don't care what so called BS "reasearch" you are quoting. Sure they may pay MOST of the claims eventually. This does not show how much effort people have to go through to fight with them to get them to pay. Almost every claim! Again - READ what I wrote.

I am not defending the company, but you have to follow the formal dispute process, which usually means in writing. The fact that you mentioned it was your company's insurance leads me to believe that your claim would be covered under ERISA, which again, has laws in place to protect employees from wrongfully denied claims. But I have never heard of a company doing reviews/appeals over the phone. Send them a letter demanding payment in full. And then if they didn't pay I would take them to court. You may want to discuss it with an attorney familiar with ERISA matters.

I Am The Law - "Humana will tell you IN WRITING why the claim denied. Be a man and call the customer service line and request this. Quit hiding on the web." My God can you not read? I am NOT a MAN! This shows how much attention you pay to what you read! If you would have read everything, you would see that my name is Tammy. I do not know of any men named Tammy. Do you? If most Humana employees pay attention like you, it is no wonder that Humana is so bad. Also, I do not appreciate your tone. I posted this to warn other people and hopefully get some sort of resolution from Humana, not to be talked to like I am some kind of moron by an arrogant individual like you. Your screen mane says it all. I have exhausted all efforts on the phone. This is all I have left, short of an attorney. I am not "hiding" from anything! Come on now, keep reading - read each word, don't skim because you will miss something. If you look at the second sentence I wrote you will see why they denied it. Read! Now, if you must reply again then read the rest of this BEFORE you reply. Read it. If you had bothered to READ what I wrote, you would have seen that they did NOT deny it after a review board looked it over. READ it. Don't just start tapping on the keyboard. The claim was not denied after the review board looked at it. The claim was accepted. The claim was accepted. The claim was accepted. Humana agreed to send a check covering 90%. Humana agreed to send a check covering 90%. Humana agreed to send a check covering 90%. Humana agreed to send a check covering 90%. Can you read this? They never sent the check. I called over and over and over. They never sent the check. I called over and over and over. I Am The Law - "if you filed the claim yourself....research the diagnosis code on the medical report submitted with the claim. You'll see what I mena. That makes this argument even more crazy because you can see what caused the denial. Research things before you start making accusations." You are telling me to research things when you can't even read a few paragraphs? I will repeat myself once again. There was no medical report. There was a reimbursement form that I filled out and the receipts for the vials. That is all. Nothing else. Do you understand? There was no medical report. My doctor did not charge me anything. The vials were $300. The claim was for the vials for $300. The form had a space asking for a reason. I wrote "For Vaccination Purposes". That is all. Can you understand this? There was no medical form. I followed Humana's instruction exactly. I did exactly what they told me to do. I sent the form they wanted. Anyway, all of that is irrelevant. It does not matter why they denied it to begin with. They accepted it after the review board. How many times do I have to write this to get it to sink in to your head? The claim was accepted. There is nothing crazy about my argument. The only thing crazy is your responses as you try so hard to defend Humana. If did not read everything and you are planning to continue grasping for reasons to defend Humana, instead of growing up and admitting that you are wrong, then please, do not contiue to spam this report. You have not been helpful. You have only made yourself look bad. Please stop now as we are getting nowhere.

By the way. Research shows that Humana pays for 99% of the claims submitted. Compare that to other carriers, slick.

It's obvious that you don't want to listen to reason. Fine, I'll quit responding to your story, but I just think you'd be better off if you'd pick up your little phone and try to work something out with the company directly. But no, I guess it's easier for you to point your little finger at the company and whine about how "evil" it is. If you spent half the energy on communication with Humana instead of making false accusations, you'd probably have solved the situation by now. But let me leave you with one final thought: If Humana denied something that was allegedly covered in your plan "just to do it", that would make that company guilty of insurance fraud. If that happened to enough people, we're talking about class action lawsuits and federal investigations. I don't see any investigators beating down the door. Oh well, I guess some people are stubborn.

It's obvious that you don't want to listen to reason. Fine, I'll quit responding to your story, but I just think you'd be better off if you'd pick up your little phone and try to work something out with the company directly. But no, I guess it's easier for you to point your little finger at the company and whine about how "evil" it is. If you spent half the energy on communication with Humana instead of making false accusations, you'd probably have solved the situation by now. But let me leave you with one final thought: If Humana denied something that was allegedly covered in your plan "just to do it", that would make that company guilty of insurance fraud. If that happened to enough people, we're talking about class action lawsuits and federal investigations. I don't see any investigators beating down the door. Oh well, I guess some people are stubborn.

It's obvious that you don't want to listen to reason. Fine, I'll quit responding to your story, but I just think you'd be better off if you'd pick up your little phone and try to work something out with the company directly. But no, I guess it's easier for you to point your little finger at the company and whine about how "evil" it is. If you spent half the energy on communication with Humana instead of making false accusations, you'd probably have solved the situation by now. But let me leave you with one final thought: If Humana denied something that was allegedly covered in your plan "just to do it", that would make that company guilty of insurance fraud. If that happened to enough people, we're talking about class action lawsuits and federal investigations. I don't see any investigators beating down the door. Oh well, I guess some people are stubborn.

It's obvious that you don't want to listen to reason. Fine, I'll quit responding to your story, but I just think you'd be better off if you'd pick up your little phone and try to work something out with the company directly. But no, I guess it's easier for you to point your little finger at the company and whine about how "evil" it is. If you spent half the energy on communication with Humana instead of making false accusations, you'd probably have solved the situation by now. But let me leave you with one final thought: If Humana denied something that was allegedly covered in your plan "just to do it", that would make that company guilty of insurance fraud. If that happened to enough people, we're talking about class action lawsuits and federal investigations. I don't see any investigators beating down the door. Oh well, I guess some people are stubborn.

I Am The Law Said Please contact Humana and ask them to walk you through the dispute process. I did this. They agreed to pay 90%. I am still waiting for my check. Where is it? I Am The Law Said Really? The claim form said that they weren't for school purposes? I can guarantee you don't know that for sure because patients NEVER see a copy of a claim submitted to the insurance company. NEVER. WRONG . I saw what was submitted, because I submitted it MYSELF. I Am The Law Said I can guarantee that the diagnosis code clearly states that the shots were for a NON-ROUTINE or NON-MEDICALLY NECESSARY reason. You should not guarantee what you do not know. You are wrong again. Remember, I filled out the form. I KNOW what was on the form. It only asked for an explanation. I wrote for vaccination purposes'. This obviously was good enough for them since they AGREED TO PAY 90%. I Am The Law Said Heaven help you if you have a mortgage or an auto loan. I have a mortgage and have had a few auto loans. I have never had any problems. What is the relevance? I Am The Law Said Why don't you quit blaming the insurance company for enforcing a policy that YOU agreed too. I never agreed to by lied to and ripped off. I Am The Law Said They act like that company is evil or something. Not evil They are liars. There is a difference. My doctor wrote me a prescription for the vials. I purchased the vials and took them back to my doctor. The nurse administered the shots. I filled out the medical reimbursement form myself and sent it in with the receipts. I know EXCATLY what was on the claim. I filled it out my self. Also, when I sent in the claim and did not hear anything, they told me Yes, I see that you sent it in, but we seem to have lost it. (real professional) Can you send another one? Since I kept the original receipts, I made another copy and sent it in again. According to I Am The Law - it is OK for a company to say "we will cover 90%. You will see a check in the mail soon." Then say "The check is still processing" every time I call to see what is taking so long, then denies all responsibility when I switch insurance companies. There is NO contract with terms like this. This is blatant flat out lying. How can you not see that? HOW? It is too bad this cannot be discussed over a phone. A phone would be so much easier than this, because you just don't seem to be able to understand anything you read. Then again, some people are so unwilling to be wrong they will argue no matter what. Although, since you do not work for Humana, there is nothing you can do to help, so there is no reason to respond.

"I Am The Law" has ignored what I have written and is set on defending this corrupt company for some unknown reason. The responses have not helped in any way. I will summarize my complaint for "I Am The Law". Please read all of it, not just what you want to read. Note - FACT -Of all of the health insurance I have had, Humana is the only one I have had problems with. FACT - I have had to fight almost EVERY CLAIM I sent to Humana. FACT - My company dropped Humana because of all of the complaints Human Resources was receiving, (mostly that Humana was refusing to pay for valid claims.) The main point of my complaint is that Humana Lied to me. Let's see if that is true. 1.) I called to be sure that the shots were covered. (Just like I have done all my life with every other company) Answer from Humana - "Yes they are covered" 2.) I asked to speak to a supervisor. Answer from Humana Supervisor "Let me look up your policy to verify. Yes it is covered. You have to pay upfront and we will reimburse you" RED FLAG - see note above 3.) I asked "Are you 100% sure? I have had nothing but problems with Humana so far. I do not want to do this and have it denied. I can go to the free clinic if I have to but I would rather not. - See Note Above Answer from Humana - "Yes, I am 100% sure that you are covered." 4.) After the first shot, I called back and asked if I should send the first one in. I also wanted more confirmation that It is covered. -See Note Above Answer From Humana - "As we told you before, yes you are covered. Wait until you have completed all three shots, then send them all in together." 5.)After sending everything in, I received notice that the claim was denied. What a surprise - See note above. 6.) I called Humana to complain. (Many calls.) Answer from Humana - We will send it to a review board. 7.) I called Humana again. Answer - "The review board has agreed to pay 90%. We will send you a check." - see note above 8.) After not receiving a check I called back. Answer from Humana - "The check is still processing. It will be there soon." -see note above 9.) I called again and again. Each time the response was the same as #8 10.) I called again after my company dropped Humana. Answer from Humana - "You are no longer covered by Humana, so we do not owe you anything." (The quotes are not direct, word for word, quotes since this happened a few years ago, but they do show basically what Humana told me.) I don't know about you, but I see quite a few lies. If you have nothing constructive and helpful, then do not spam my complaint again. I am sick of people defending corrupt companies. Remember, I have NEVER had a problem with any other insurance company in my life.

Humana will tell you IN WRITING why the claim denied. Be a man and call the customer service line and request this. Quit hiding on the web.

if you filed the claim yourself....research the diagnosis code on the medical report submitted with the claim. You'll see what I mena. That makes this argument even more crazy because you can see what caused the denial. Research things before you start making accusations.

if you filed the claim yourself....research the diagnosis code on the medical report submitted with the claim. You'll see what I mena. That makes this argument even more crazy because you can see what caused the denial. Research things before you start making accusations.

if you filed the claim yourself....research the diagnosis code on the medical report submitted with the claim. You'll see what I mena. That makes this argument even more crazy because you can see what caused the denial. Research things before you start making accusations.

if you filed the claim yourself....research the diagnosis code on the medical report submitted with the claim. You'll see what I mena. That makes this argument even more crazy because you can see what caused the denial. Research things before you start making accusations.

Really? The claim form said that they weren't for school purposes? I can guarantee you don't know that for sure because patients NEVER see a copy of a claim submitted to the insurance company. NEVER. They only see the results of what paid out or didn't pay out. Without even looking at it, I can guarantee that the diagnosis code clearly states that the shots were for a NON-ROUTINE or NON-MEDICALLY NECESSARY reason. Why don't you quit blaming the insurance company for enforcing a policy that YOU agreed too. I get so tired of people blaming companies they deal with for holding to a contract that someone got themselves into. They act like that company is evil or something. Just because YOU didn't read the contact, but agreed to it, now you won't accept responsibility when something bad happens. Heaven help you if you have a mortgage or an auto loan.

After they denied the claim, I called to ask why. They would not give a reason. I told them I had called before and was told it is all covered. They put me on hold then came back and told me, "Yes I see that you called. I asked them to send it to a review board. I called back later, since they never bothered to call me back. They then told me after it went to a review board "we have decided that it is coverd but we only cover 90% because it is considered a medical neccesity." They told me they would send a check for 90% of the cost. I waited and no check arrived. I called back and was told "It is still in process." I kept waiting and calling and they kept giving me the same answer. Finally, they told me that "too much time has passed so we are not going to cover it." After arguing with them, they agreed to look into it again. I called again and this time I was told "You no longer have Humana insurance so we will not cover your claim." (My company had recently changed insurance companies due to all the complaints Human Resources had recieved from employees about Humana.) I had Humana durring this whole process. They strung me along for years. They lied. They lied again. They cheated me. They ripped me off.

What is so hard to understand? Let me be even more specific then. There was nothing on the claim about school. The vaccine Is covered. Can you not read? My policy states that all vaccines are 100% covered. All the claim stated was I recieved three vaccines. Nothing else. My policy states all Vaccines are 100% covered. I repeat - read this - My policy states that ALL vaccines are 100% covered. Maybe when you worked for them they were not all covered. They were covered when I recieved the vaccine. This is not open for debate. They were covered. This is a fact. One more time - the claim did NOT say the shots were for school. I sent the claim in myself. There was nothing about school on the claim.

Come on now. Humana can tell you if shots are covered or not, sure. But there was absolutely no way to predict that the claim would say that the shots were for school. (Again, shots for this purpose are never covered. Read the certificate's exclusions section.) You're asking Humana to predict what information will come in on a claim that they didn't even have at the time. Humana associates are required to read a disclaimer saying that what any benefits you hear over the phone are estimations, not guarantees. This is to safeguard the company from people saying that Humana lied about benefits. Again, this is not Humana's fault; you were not ripped off. Please contact Humana and ask them to walk you through the dispute process.

Just to clarify - vaccines are 100% covered under my Humana insurance plan. The issue is not the fact that it was a vaccine, the issue was that I had to purchase the three vials. Humana said it was covered under the medical insurance because it is a vaccine. Once again - my policy states that vaccines are 100% covered.

Just to clarify - vaccines are 100% covered under my Humana insurance plan. The issue is not the fact that it was a vaccine, the issue was that I had to purchase the three vials. Humana said it was covered under the medical insurance because it is a vaccine. Once again - my policy states that vaccines are 100% covered.

Just to clarify - vaccines are 100% covered under my Humana insurance plan. The issue is not the fact that it was a vaccine, the issue was that I had to purchase the three vials. Humana said it was covered under the medical insurance because it is a vaccine. Once again - my policy states that vaccines are 100% covered.

Just to clarify - vaccines are 100% covered under my Humana insurance plan. The issue is not the fact that it was a vaccine, the issue was that I had to purchase the three vials. Humana said it was covered under the medical insurance because it is a vaccine. Once again - my policy states that vaccines are 100% covered.

Perhaps you did not read everything. It is irrelevant if it is normally covered or not. Humana told me is is covered. They continued to tell me it is covered for months as I paid for one shot after the other. Once I paid for the last shot, they decided that it was now not covered. I could have had these shots for free at a clinic. All Humana had to do was tell me that they were not covered. No matter how you look at it, Humana lied. They lied and cost me money. They owe me money.

I'm sure that your policy covered normal vaccinations to some extent. (if not 100% covered.) I've worked for the company for some time and what you're describing is called "vaccinations for administrative purposes." These are vaccinations for getting a job, insurance coverage, travel, participation in sports, or for school. I have never seen a policy in my time at Humana that covered vaccinations for those purposes. Read the Exclusions section of your policy and I'm sure you'll see it clearly spelled out there.