As I mentioned in a post last November, my university changed health insurance providers. We used to have Anthem, but now we have Humana. I was never a fan of Anthem (who can be a fan of his/her health insurance provider), but I had gotten used to it. I pretty much knew what was going to go smoothly and what was going to become a problem. Now, I have that learning curve again with Humana, and I can officially say that Humana sucks.
I went to the doctor yesterday to renew my prescription for my ADHD medicine. With Anthem, I used their mail-in pharmacy, and though it never took less than 3 weeks for the prescription to arrive, Anthem always covered it. Since I was fearing that the new mail-in pharmacy provided by Humana was going to be worse than that of Anthem, I asked my doctor to write me a 30 day prescription that I could fill out at my local pharmacy. I'd rather pay the extra $20 it would cost me every three months to fill it locally, than deal with mail-in pharmacies customer service (hint: they are way worse than whatever I've ever dealt with an insurance. And that is a lot to say). After the doctor's appointment, I went to my local CVS to fill the prescription. And surprise, surprise... Humana denied the claim. First, they said they would cover up to 2/3 of what my doctor prescribed. But even that wouldn't go through. I watched as the patient pharmacist at CVS was on the phone with Humana for 25 minutes, being pass around and never getting an answer. The only clue they got was that they told her that my doctor would have to fax an authorization and my medical history regarding ADHD to Humana for them to process and cover the medication. It has never happened to me with Anthem! And it is a generic (though a very expensive one) what I have a prescription for, not a new drug that they refuse to cover. I was furious. She called my doctor, and so did I, and they promised to fax everything to Humana that same day. But I have no idea what the outcome will be, and just having to go through the hassle and the perspective of having to fight over the phone with a customer service representative (actually, I think they call them patient advocate, misnomer if I've ever heard one) just caused my anxiety to go through the roof. As an Argentinean, I am used to long lines just to pay a bill or to do a bureaucratic errand, but trying to reason on the phone with somebody I suspect is getting paid to deny claims just terrifies me. Because you know you are at their mercy, and there is no amount of talk and reasoning that can change their decision. So let's hope everything goes on smoothly, but I am not holding my breath. And I take this incident as an indication of similar things to come from Humana. I know this is nothing compared to the situations many people go through (and let's not even talk about the uninsured), but I had to stop crying before I was able to drive to the airport to pick my parents. It is in situations like this that I hate the United States. In Argentina, even if I was uninsured, I would have to go through long lines and spend a lot of time just to get an appointment. But I would get care. And people are more human.
F**ck Humana! That's all I can say. And I wrote this post a day after the incident happened (still no news), just to calm down before writing. F**ck!
that sucks. the drug company that makes fMhson's meds has some mail in program of its own. I'm thinking of trying that. Otherwise I'm planning to go to our local non-chain pharm figuring that they will be more motivated to deal with ins as this is a high profit drug
ReplyDeleteI will have to deal with Humana. But I will say I was surprised how wonderful the people behind the counter at CVS were. Maybe it's their job, but I was still impressed. I will see what I can do, if Humana keeps giving me problems. I take the XR (extended release) version of Adderall, which is really expensive. If Humana doesn't want to pay for it, I'll have to ask my doctor for a normal, old-fashioned generic (which are really cheap). It doesn't thrill me, because I feel like I'm taking speed. But since I don't take it every day either, it is the last solution.
ReplyDeleteDoes your insurance cover your son's drug?
I came across your post while googling Humana and I'm afraid to confirm--as of the beginning of the year, Humana is furiously fighting claims and will deny, deny deny claims. I work in a hospital and went to a seminar that Humana held to explain their new "policies" and to make a long story short: In order to have specialized, expensive treatment covered by Humana, you must meet the criteria to the 100%, not 95%, not 98%. They will try to knock you down to the cheapest care level possible, with very little thought to your health. We are fighting for one of our patients right now to be discharged to a neurorehab unit, but Humana keeps denying it. They are basically sending her home to vegetate. The family finally threatened legal action and miracously, Humana authorized the transfer to the neuro unit. They claim it's to save money, but are they passing the savings on to their insured? Absolutley not. I wouldn't get Humana now if it were free.
ReplyDelete@Anonymous: Thank you very much for sharing your story here. I had heard that at least in my city (mid-size city in the Midwest) they were aggressively trying to get new corporate clients and at the same time trying to reduce doctor's compensation. Unfortunately, I am not surprised to hear your story. I have also found that their website has a lot of glitches and, for some reason, the PDF of over 100 pages with what is covered and not on my plan keeps dissapearing every so often.
ReplyDeleteAs for the story I wrote about in this post, I spoke to them later. The pharmacist was trying to fill a prescription that contained 90 pills (3 a day). They refused it, and after much battle, they told her (or it appeared on the screen) they paid up to 78 pills (???). When she tried to billed them for that, they rejected it again. When I spoke to somebody at Humana, they said that the pharmacist had made a mistake because they only paid up to 77 (???) pills, so that's why the claim got rejected. A mistake by my pharmacist? I don't think so, she spent half an hour on the phone with them on my behalf. I really think the gave her false information not to pay the prescription.
The only small consolation is that you said you find this googling Humana. Maybe more people will and contribute to the story.
I have Humana Select Insurance. Every time I see a doctor I find myself on the phone with Humana battleing. I pay 600 dollars a month to them foe health, dental, and vision. Yet I still have to fight them for everything. I have a really bad back and I have been sitting with my back swollen and barely able to move because I am in so much pain for two weeks now, waiting for Humana to approve me to see a specialist about it. They are ridiculous. I agree F*** Humana!!
ReplyDelete