Complaint Review: Humana - Lexington Kentucky

Jenny if you can give me some details about the situation, I'll do what I can to help. I'm afraid your report is a bit vague. If you like, you can call me at 877-285-4630 and I'll walk you through whatever is going on.

Go ahead and file suit- I don't have a problem with that. As for OP, this complaint exposes Humana's lack of response to its clients. Call Humana all you like. Questions are often not answered. Answers we do get are often inaccurate and ambiguous. Humana's clients end up with festering illnesses, and the nagging anxiety of not knowing whether the treatment is "covered" or not. No complaints department to increase quality of service. Post on this forum, we get blasted by Humana's goon squad. As with the scores of other complaints about Humana on this forum, I would suggest Humana open a simple inexpensive complaints department to request advice from an educated employee. I think it may solve the problem, and is not "illegal."

No more help from me, Franzg. I'm done wasting my time trying to fill you in on things. You lie and lie and lie some more. You've even created an alter-ego on ROR to "back up" your twisted opinions. Even without specific details on the situation from the author, you still blame Humana for the situation. Tsk tsk tsk. Sad, really. You are so full of hate. Good-bye, I hope Humana doesn't sue you for libel.

No more help from me, Franzg. I'm done wasting my time trying to fill you in on things. You lie and lie and lie some more. You've even created an alter-ego on ROR to "back up" your twisted opinions. Even without specific details on the situation from the author, you still blame Humana for the situation. Tsk tsk tsk. Sad, really. You are so full of hate. Good-bye, I hope Humana doesn't sue you for libel.

It is becoming quite detrimental to these threads when you do not read the original complaint before posting: "The numbers are simple, I've called eightey(sic) some times, I file each claim an average of 2.5 times per claim". Clarity would help. Why not give details in original denial? We pay Humana lots of money to service our healthcare. Maybe Humana employees should start answering their telephones, and try to help their clients whose money keeps Humana afloat. I guess you still think Humana answers all its calls, and always gives helpful advice on how to correct problems with its clients' claims. From the looks of these reports, I am skeptical of the validity of that assumption.

Ok Franzg, if you feel like something wasn't explained in great enough detail on an EOB, try calling Humana for more information. Humana's phone number is 800-448-6262. You do know how to use the phone, right? Just a hint, don't use the phone that says "Fisher Price" on the front; that one only calls Big Bird.

Yes, that is the way Humana operates. I'm glad you think this practice is humorous. I'm sure Humana executives are also laughing all the way to the bank as well. The "reason for denial" is usually a statement like "not covered" or "not filed properly". Of course, Humana gives no clues or hints what is actually wrong with the claim for covered services. Could be wrong form, wrong DOB, wrong numbers, wrong color ink etc... If you actually read the complaints on this site, you will find I am speaking the truth. You can deny this all you like, but it happens all the time. By doing this, one must file a "written grievance or appeal" instead of being able to correct a numerical error, or most commonly, blunders on Humana's part. You could actually gain a little respect on this site if you started to actually read the complaints, and responding appropriately in a helpful manner, rather than to call people "liars", "stupid" and "on drugs." You are obviously rather unprofessional in your tone. Mockery of clients does not help Humana or the client one bit.

Franzg, If a claim denies, you seriously think Humana doesn't put a reason on the EOB? Wow, either: A. your unfounded revenge against Humana is driving you to outright lie. B. you've never seen an Explanation of Benefits. C. you're on drugs. D. all of the above. So which one is it? Your statement is laughable. Not only is it a law that a denial reason has to be on the EOB, but even if that wasn't the case, what would the purpose of sending it out be in the first place? Ha ha ha.

Probably someone filled out wrong form, or forgot to use proper Humana legalese. My guess is Humana employees do not understand English. But you are probably right. Humana does not have to explain anything to anyone. Their policies cover nothing in the first place, so the claims are denied. Most denied EOBs state "not covered". No further explanation needed, and no one will answer the Humana phones. This stuff is all over Ripoff Report- Please read the 30 current complaints. I guess then a patient advocate would be no help because Humana is so clear about their denials. Heck, you have even been brainwashed to think a saliva test is an office visit. Now get back to work, and start writing some ambiguous and contradictory policies. Time is running out for managed care- better make the big bucks while you still can!

Franzg, If a claim denies, you seriously think Humana doesn't put a reason on the EOB? Wow, either: A. your unfounded revenge against Humana is driving you to outright lie. B. you've never seen an Explanation of Benefits. C. you're on drugs. D. all of the above. So which one is it? Your statement is laughable. Not only is it a law that a denial reason has to be on the EOB, but even if that wasn't the case, what would the purpose of sending it out be in the first place? Ha ha ha.

I agree. Find a patient advocate, if you can. They are legal counsel with training in how to navigate the complicated labyrinth of filing claims with managed care. Could save you a lot of headaches in the future.

In regards to there being no complaint department, I believe the hospital should have a Patient Advocate who may be to help with this situation. Call the hospital to see if there is one there.

In regards to there being no complaint department, I believe the hospital should have a Patient Advocate who may be to help with this situation. Call the hospital to see if there is one there.

In regards to there being no complaint department, I believe the hospital should have a Patient Advocate who may be to help with this situation. Call the hospital to see if there is one there.

"The numbers are simple, I've called eightey(sic) some times, I file each claim an average of 2.5 times per claim. Yes, this is the definition for Humana" Sounds like the OP gets no response. Sure you get EOB. Reason for denial is omitted. It is a secret. Human a does not want you to know. Someone probably forgot to check a box, or cross a "T" or used wrong color ink or something like that. Then, just don't answer the phone. Case closed. Humana wins again. This kind of stuff is all over ROR.

"The numbers are simple, I've called eightey(sic) some times, I file each claim an average of 2.5 times per claim. Yes, this is the definition for Humana" Sounds like the OP gets no response. Sure you get EOB. Reason for denial is omitted. It is a secret. Human a does not want you to know. Someone probably forgot to check a box, or cross a "T" or used wrong color ink or something like that. Then, just don't answer the phone. Case closed. Humana wins again. This kind of stuff is all over ROR.

"The numbers are simple, I've called eightey(sic) some times, I file each claim an average of 2.5 times per claim. Yes, this is the definition for Humana" Sounds like the OP gets no response. Sure you get EOB. Reason for denial is omitted. It is a secret. Human a does not want you to know. Someone probably forgot to check a box, or cross a "T" or used wrong color ink or something like that. Then, just don't answer the phone. Case closed. Humana wins again. This kind of stuff is all over ROR.

"The numbers are simple, I've called eightey(sic) some times, I file each claim an average of 2.5 times per claim. Yes, this is the definition for Humana" Sounds like the OP gets no response. Sure you get EOB. Reason for denial is omitted. It is a secret. Human a does not want you to know. Someone probably forgot to check a box, or cross a "T" or used wrong color ink or something like that. Then, just don't answer the phone. Case closed. Humana wins again. This kind of stuff is all over ROR.

I'd be happy to help, but I need some more info. Why are the claims being turned away the first time? What is the denial on your EOB?

The complaint, I believe, is about a client of Humana's getting the "runaround" on the telephone. You now claim the client needs to write an appeal letter which is to be scanned for authenticity, and forwarded to a government office. I don't think the original post has anything to do about the appeals process. I believe Humana's client is trying to check on the status of an insurance claim. The client got frustrated, because the calls are rarely answered. I would not advise this client to file a written "appeal" at this point. Would you? Sounds like crummy customer service. A problem which is best handled by a complaints department. Now go back to work, and start counting the number of gauze pads used to amputate a diabetic patient's leg. They may be over the limit, and now should be charged accordingly.

What part of "It's a law that the appeal must be mailed" don't you get, Franzg? You don't have to like it, just accept the fact. Whenever there is a dispute between my hospital and Humana (if I feel they shorted a payment for example), even I have to make appeals in writing and send them through the mail. Considering my job responsibilities, yes, it would be easier to fax these documents, but I'm not going to ask Humana to break the law. If you're not happy with the law, I'd suggest writing your Congressperson. Until then, cease your silly "It should be this way" arguments. Don't cry about something if you're not willing to try to change it.

What part of "It's a law that the appeal must be mailed" don't you get, Franzg? You don't have to like it, just accept the fact. Whenever there is a dispute between my hospital and Humana (if I feel they shorted a payment for example), even I have to make appeals in writing and send them through the mail. Considering my job responsibilities, yes, it would be easier to fax these documents, but I'm not going to ask Humana to break the law. If you're not happy with the law, I'd suggest writing your Congressperson. Until then, cease your silly "It should be this way" arguments. Don't cry about something if you're not willing to try to change it.

What part of "It's a law that the appeal must be mailed" don't you get, Franzg? You don't have to like it, just accept the fact. Whenever there is a dispute between my hospital and Humana (if I feel they shorted a payment for example), even I have to make appeals in writing and send them through the mail. Considering my job responsibilities, yes, it would be easier to fax these documents, but I'm not going to ask Humana to break the law. If you're not happy with the law, I'd suggest writing your Congressperson. Until then, cease your silly "It should be this way" arguments. Don't cry about something if you're not willing to try to change it.

What part of "It's a law that the appeal must be mailed" don't you get, Franzg? You don't have to like it, just accept the fact. Whenever there is a dispute between my hospital and Humana (if I feel they shorted a payment for example), even I have to make appeals in writing and send them through the mail. Considering my job responsibilities, yes, it would be easier to fax these documents, but I'm not going to ask Humana to break the law. If you're not happy with the law, I'd suggest writing your Congressperson. Until then, cease your silly "It should be this way" arguments. Don't cry about something if you're not willing to try to change it.

The client seeks information, and is trying to follow up on a claim. They call Humana numerous times, and get no help. YOU recommend they file an appeal. An appeal for what? Why can't Humana have a fax machine to receive complaints about its inefficient service? Because Humana is chicken. It is not a DOI guideline that makes fax machines illegal. If one wants to complain about getting the runaround, they need to file a "wriiten appeal" to the DOI. That's the way Humana wants it. It's cheaper to pass the buck back to the government. I'm quite sure the DOI is not very interested wasting its time on Humana's lack of ability to answer a telephone, or its stupidity in not having a fax machine.

Franzg, AGAIN, it's a DOI guideline that dictates that all appeals must be in writing; that's not merely a Humana policy. In lamens terms, it's a law. I don't know how many times I need to tell you that. The logic for this is that there are statutes on how long an insurance carrier has to react to an appeal. That timeframe roughly starts from the postmark on the envelope. (This is why insurance carriers store an image of the envelope as well as the actual letter.) Faxes can be easily altered with a little cut and paste action, so there's your answer.

Are fax machines illegal? I'll tell you what- I'll give Humana $100 to buy a fax machine. At least we would have some documentation that it receives our "grievances". Oh, sorry- You call it "whining".

Department of Insurance guideline: All grievances must be in a written form. This is not a Humana rule, it's a law. Do you want Humana to violate that guideline just so you'll not whine?

We now officially have a "gag order". No verbal complaints allowed. I think that's just "Quacktastic" Great way to run a company which is responsible for our healthcare.

We now officially have a "gag order". No verbal complaints allowed. I think that's just "Quacktastic" Great way to run a company which is responsible for our healthcare.

We now officially have a "gag order". No verbal complaints allowed. I think that's just "Quacktastic" Great way to run a company which is responsible for our healthcare.

We now officially have a "gag order". No verbal complaints allowed. I think that's just "Quacktastic" Great way to run a company which is responsible for our healthcare.

Humana Grievance and Appeal PO BOX 14546 LEXINGTON, KY 40512. Humana's phone number is 800-448-6262 (also for complaints.) Department of Insurance guidelines dictates that ALL grievances to any carrier MUST be in writing. I would imagine they want it this way so conspiracy theorists don't use the old "they ignored my phone call" bit and it also puts a hand written signature in place for legal purposes. Any other questions, feel free to blog back something quacktastic.

I guess the issue now is that you are liable for lawsuit if you complain about Humana employees not responding to clients. Beware bloggers, you will be sued for complaining. Why doesn't Humana care for its clients and open a complaints department? I still don't know. Right now, all we have is ripoff report. I guess Humana should hold us all liable for complaining. Seems it could do better than trying to sue a blogger trying to get advice Humana won't give.

You can be sued for libelous comments in a blog. Read the following article: In an editorial published Sunday the editors of the Dallas Morning News, while praising bloggers, warned them - particularly younger ones ... ... that they could be sued for libel (free registration or BugMeNot required) ... "We hate to spoil the fun, but there's something you newbie bloggers need to know before committing journalism on your shiny new Web sites: You are now a publisher and could be sued for libel. Libel law, as it applies to this new Internet form of journalism, is still being worked out in the courts. But bloggers and those who post comments on chat boards should be aware that in most cases, the same libel and privacy laws that govern the conduct of professional journalists also apply to them. One important distinction: A blogger generally cannot be held liable for libelous material posted by someone else on the blogger's Web site. But any content created by the blogger is subject to a libel claim. It's great fun to waylay your enemies with scorching online invective - but if you (or, parents, please note, your children) cross the libel line while online, look out for lawyers." Steve Rubel is a PR strategist with nearly 16 years of public relations, marketing, journalism and communications experience. He currently serves as a Senior Vice President with Edelman, the largest independent global PR firm.He authors the Micro Persuasion weblog, which tracks how blogs and participatory journalism are changing the public relations practice.

Oh, I hope I don't get sued by Humana for expressing my opinion. Is the corporation itching to defend itself by suing citizens? What is the big deal? Is Humana that scared? Why doesn't it open a complaints department, so it wont have to sue consumers to make more money?

Political rhetoric aside Franzg, you have now crossed the line into typing libel, which you can be sued for. Someone at Humana would get fired if they paid a claim? Come on. Use your head. If that was true, Humana would have no business. Careful what you type, my man, they could be reading this and forwarding it to their lawyers.

I believe this consumer is one of many victims of managed care's vision to suck up as much money as it can, and to make the reimbursement as tedious as possible. That way, the managed care company gets to keep your money. Its big business. It makes money on our physical ailments. The sicker you are, the more expensive it is. The older you are, the less you get covered. The more you complain, the more inaccessible it becomes. You cannot file a complaint against anyone at Humana. You can only complain in writing, and you don't have anyone's name anyway. It is designed that way. If you try to cooperate with it, it will just punt your bill elsewhere. They already have your money. Their job is to NOT PAY. One would get fired if they promptly paid 100% of your medical care in a managed care setting. Someone has to give up first, and believe me, Humana will never give up trying to keep your money. It is a game of attrition. If you are ill, you will have a very hard time fighting to get your bill covered. Its better for your health to be well prepared to pay for it yourself, or might die waiting for your important medical procedure.

Can you fill me in a bit more? I need some detail here. What address are you sending it to? The more detail on the situation the better.