Re: Humana choice care PPO
Jim DeWees
Description
Collection
Title:
Re: Humana choice care PPO
Creator:
Jim DeWees
Date:
1/19/2011
Text:
Ted, and everyone else,
I have been having several issues with Humana Choice care as well. I have problems with ALL Humana claims, including the Medicare Advantage plan that they also offer.
I hope this email will help others to find ways to help correct these problems that Humana has created, and the problems they are creating that affect many of our seniors in getting the proper healthcare treatments they need.
The problems I have encountered, which is on ALL Humana claims, is that Humana will get the claims (electronically), and then never reply back to us as the provider. I have to call their customer/claim center, which is in the Phillipines. There is NO number in the US to call, and no way for anyone in Manilla to transfer a call to any person in the US. They will try to answer the questions, and everything else, but they can NOT do anything to correct these problems.
They ALWAYS will say they are not processing the claim because of missing medical documentation for support of the claim....BUT they NEVER send anything to me saying this information is needed. Once I get that message from a phone call, I write a letter stating why a person needs a prosthetic limb. I fax this letter to Humana, and then they will process the claim. BUT, they never pay ALL the codes, and so we go through this process again and again....up to 6 times to get ONE page of codes paid by Humana.
After dealing with this several times, and getting totally frustrated to a point where I have told some patients that they MUST change their insurance if they want to continue to come to my facility, and I am not the only provider telling them to change. In fact, after speaking with several doctors here in my area, many of them are NOT providing service for Humana policy holders. Most of their patients have already changed back to the traditional Medicare plans.
But the best and most powerful tool I have found to get someone at Humana to contact me was when I filed a few complaints with the Office of Inspector General regarding this kind of treatment from Humana. They took my complaints seriously, and they have checked into Humana, and within 2 weeks of my compaints, I had someone from the USA calling me from Humana. I was actually on vacation and had the phones tranferred to my cell phone, and missed the first 2 calls from her. But, while standing in line at Disneyworld, I got the call from her, and had time to speak with her.
She asked me to please remove my complaints with the OIG, and I said that I will do that ONLY after I get a claim to go through with NO hangups, and no glitches, and where I don't have to spend HOURS on the phone with someone in the Phillipines who runs me around in circles. Once I can get GOOD service from Humana, then I will remove my complaints. But, I am sure that I will be making MORE complaints with the OIG to get these issues resolved.
After this conversation, and explaining ALL 3 of the patients' claims, she took that all down, and all the claims were finally paid. These claims went back for 11 months in one case, and 6 months for the others. There are 4 more in the works, that also have problems, but are going to be resolved soon I hope.
So, my encouragement to everyone here is to contact the local OIG office, and launch complaints against Humana and any other company (Anthem) who also has these kind of stall tactics, or missing payments, or any time that the precertification has been obtained, but claims not being paid based on missing precert information is the excuse the list for not paying a claim.
I also submit all these issues to the Indiana Dept of Insurance for them to keep records on these insurance companies and let them take action.
If these government watchdogs aren't informed of these issues and problems, then they can't do their jobs to make these companies deal better with the providers. Maybe, just MAYBE, if enough complaints are filed, and these offices are swamped with concerns and problems, then they might take stiffer action, including exclusions in these companies from participating in the Medicare Advantage programs.
The bottom line is, the ONLY way I got to speak with someone in the USA about this, and finally get these claims paid, was after filing complaints with the OIG. It didn't take more than about 20 minutes of my time to find the number, call them, explain it to them, including claim numbers, and they were right on this. Please, take the time to do the same, and you will get the attention of these companies when you do this.
Good luck, it is getting harder and harder to get decent treatment in this field.
Jim DeWees, CP
> Date: Fri, 7 Jan 2011 13:45:21 -0500
> From: <Email Address Redacted>
> Subject: [OANDP-L] Humana choice care PPO
> To: <Email Address Redacted>
>
> Can anyone fill me in on dealing with this organization?
>
>
> Ted A. Trower CPO, FAAOP
> A-S-C Orthotics & Prosthetics
> Jackson, MI
> Continuing Education Chairman
> Michigan Orthotics & Prosthetics Association
>
>
I have been having several issues with Humana Choice care as well. I have problems with ALL Humana claims, including the Medicare Advantage plan that they also offer.
I hope this email will help others to find ways to help correct these problems that Humana has created, and the problems they are creating that affect many of our seniors in getting the proper healthcare treatments they need.
The problems I have encountered, which is on ALL Humana claims, is that Humana will get the claims (electronically), and then never reply back to us as the provider. I have to call their customer/claim center, which is in the Phillipines. There is NO number in the US to call, and no way for anyone in Manilla to transfer a call to any person in the US. They will try to answer the questions, and everything else, but they can NOT do anything to correct these problems.
They ALWAYS will say they are not processing the claim because of missing medical documentation for support of the claim....BUT they NEVER send anything to me saying this information is needed. Once I get that message from a phone call, I write a letter stating why a person needs a prosthetic limb. I fax this letter to Humana, and then they will process the claim. BUT, they never pay ALL the codes, and so we go through this process again and again....up to 6 times to get ONE page of codes paid by Humana.
After dealing with this several times, and getting totally frustrated to a point where I have told some patients that they MUST change their insurance if they want to continue to come to my facility, and I am not the only provider telling them to change. In fact, after speaking with several doctors here in my area, many of them are NOT providing service for Humana policy holders. Most of their patients have already changed back to the traditional Medicare plans.
But the best and most powerful tool I have found to get someone at Humana to contact me was when I filed a few complaints with the Office of Inspector General regarding this kind of treatment from Humana. They took my complaints seriously, and they have checked into Humana, and within 2 weeks of my compaints, I had someone from the USA calling me from Humana. I was actually on vacation and had the phones tranferred to my cell phone, and missed the first 2 calls from her. But, while standing in line at Disneyworld, I got the call from her, and had time to speak with her.
She asked me to please remove my complaints with the OIG, and I said that I will do that ONLY after I get a claim to go through with NO hangups, and no glitches, and where I don't have to spend HOURS on the phone with someone in the Phillipines who runs me around in circles. Once I can get GOOD service from Humana, then I will remove my complaints. But, I am sure that I will be making MORE complaints with the OIG to get these issues resolved.
After this conversation, and explaining ALL 3 of the patients' claims, she took that all down, and all the claims were finally paid. These claims went back for 11 months in one case, and 6 months for the others. There are 4 more in the works, that also have problems, but are going to be resolved soon I hope.
So, my encouragement to everyone here is to contact the local OIG office, and launch complaints against Humana and any other company (Anthem) who also has these kind of stall tactics, or missing payments, or any time that the precertification has been obtained, but claims not being paid based on missing precert information is the excuse the list for not paying a claim.
I also submit all these issues to the Indiana Dept of Insurance for them to keep records on these insurance companies and let them take action.
If these government watchdogs aren't informed of these issues and problems, then they can't do their jobs to make these companies deal better with the providers. Maybe, just MAYBE, if enough complaints are filed, and these offices are swamped with concerns and problems, then they might take stiffer action, including exclusions in these companies from participating in the Medicare Advantage programs.
The bottom line is, the ONLY way I got to speak with someone in the USA about this, and finally get these claims paid, was after filing complaints with the OIG. It didn't take more than about 20 minutes of my time to find the number, call them, explain it to them, including claim numbers, and they were right on this. Please, take the time to do the same, and you will get the attention of these companies when you do this.
Good luck, it is getting harder and harder to get decent treatment in this field.
Jim DeWees, CP
> Date: Fri, 7 Jan 2011 13:45:21 -0500
> From: <Email Address Redacted>
> Subject: [OANDP-L] Humana choice care PPO
> To: <Email Address Redacted>
>
> Can anyone fill me in on dealing with this organization?
>
>
> Ted A. Trower CPO, FAAOP
> A-S-C Orthotics & Prosthetics
> Jackson, MI
> Continuing Education Chairman
> Michigan Orthotics & Prosthetics Association
>
>
Citation
Jim DeWees, “Re: Humana choice care PPO,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/232189.
