Complaints
This profile includes complaints for Humana, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see
Customer Complaints Summary
- 294 total complaints in the last 3 years.
- 112 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.
Initial Complaint
Date:01/24/2024
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
A dental procedure was performed on 10/19/2023 and the claim was submitted to Humana. The claim was initially denied due to an address discrepancy despite other claims being approved with the same address discrepancy. Then the claim was denied due to a missing narrative by the periodontist. Then the claim was denied because Humana said they were missing periodontal charting (which the DMD sent in 3 separate times). Then in January 2024 the claim was denied because Humana said it was a medical claim. I sent the claim to my medical insurer who stated the claim was dental. I sent the letter from my medical insurance saying it was dental so Humana could process the claim. Supposed supervisors have escalated the claim to critical and promised outreach to me on the status of the claim. There has been no communication from Humana on the status of the claim despite my continued outreach. Humana has never provided outreach as to the denial of the claim. I have spent hours on the phone with Humana trying to get this claim that's over 3 months old resolved and I am not getting anywhere with any of the offshore call center representatives I've talked with.
Business Response
Date: 02/02/2024
Please see attached response.Business Response
Date: 02/09/2024
Please see attached response.Initial Complaint
Date:01/23/2024
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
My physiotherapist signed off on a mobility scooter for me due to my 4 fractures in my back and my recent hip replacement and sent the forms over to doctors office and Humana to be processed on September 25th 2023. This should have taken no longer than 6 weeks but after phone call after phone call every single week still no mobility scooter with excuse after excuse and each blaming the other who had not taken care of the situation. After filling 2 grievances with Humana and multiple phone calls they finally got the mobility scooter actioned after 3 different providers and 3 months later. The issue now being as it took so long now my deductible of $500 has to be paid again as it is a new year. I do not have the $500 as an 81 year old that is on social security but if it was done correctly by Humana in the first place and back in September when the form was approved the deductible was already met for the year so I would not be in this situation if they had done there job. My daughter law has been the one to continually call as I have been to unwell and she lives in Australia. They came over here to America in September to make sure it was all in place as I have no family here and am alone. Please see the phone bills of the countless times she has called to chase this up. There are 4 pages of overseas calls to Humana, doctors office and the 2 previous providers.Business Response
Date: 02/02/2024
Upon receipt of this inquiry, a thorough review of the issue was completed. The complaint was sent to Humana’s Clinical Intake Team (CIT) for review and resolution. It was determined that Humana did not receive an authorization request for a mobility scooter during the 2023 plan year. According to your 2024 Explanation of Coverage (EOC) on page thirty-six (36) your deductible is $500.00. Until you have paid the deductible amount, you must pay the full cost for most of your covered services. Once you have paid your deductible, Humana will begin to pay our share of the costs for covered medical services and you will pay your share (your copayment or coinsurance amount) for the rest of the calendar year. Lastly on page forty-five (45) it states that for your Durable medical equipment (DME) and related supplies received at an in-network (INN) DME supplier you are responsible for a fourteen (14) percent coinsurance and at an out-of-network (ONN) DME supplier you are responsible for a twenty-five (25) percent coinsurance. On February 2, 2024, a detailed resolution letter was mailed to your mailing address on file.Customer Answer
Date: 02/04/2024
Complaint: ********
I am rejecting this response because:I sent you copies of the phone bills made to Humana and the companies that humana gave me in 2023 and called them to get updated of the scooter in 2023 so this is not true look at all my documents that were sent over
Sincerely,
******* *******Business Response
Date: 02/09/2024
As stated in our previous response dated February 2, 2024, Humana did not receive an authorization request for a mobility scooter during the 2023 plan year. Your telephone records were received and reviewed, and it confirmed that you contacted Humana on August 8, 2023, to find out your benefits for a wheelchair. The Customer Service representative provided you with your Durable Medical Equipment (DME) benefits for the 2023 plan year. Your daughter in-law contacted Humana on December 15, 2023, to inquire on the status of your PA for a motorized scooter. She informed Humana’s Customer Service representative that you had been waiting three (3) months, after being told that it could be a two (2) month process. The Customer Care representative made an outbound telephone call to your doctor’s office and was informed that an order was faxed to Caremax Health on November 30, 2023. Your daughter-in-law contacted Humana again on December 28, 2023, upset because there had not been a resolution to the grievance you submitted on December 27, 2023, regarding the DME authorization process. Humana’s Clinical Intake Team (CIT) did not receive a prior authorization request from Caremax Health for a mobility scooter until January 8, 2024. I detailed resolution letter was mailed to you on January 9, 2024.Customer Answer
Date: 02/14/2024
Complaint: ********
I am rejecting this response because:The information is incorrect. Please see phone bill again that is attached first one highlighted in Yellow is from my daughter in law calling Humana on 9th November to follow up on the mobility scooter as it had been the 2 months since the doctors office and Humana said it would take. 24 minute phone call with Humana as you can see and that is why they also contacted there provider Adapt health care whom they said would be supplying the mobility scooter and will be processed in 24 hours.
November 11th still no word so another call to Humana by my daughter in law for 12 minutes see yellow highlighted. Humana then gave me Adapt medical equipment contact number direct and also called them while my daughter in law was still on the phone as they were providing the scooter and was told the order was being processed.
November 21st my daughter in law called Adapt medical equipment from the contact information Humana gave her and they did apologize and said they will work on the order right away. (phone call highlighted in purple) 9 minutes.
After being extremely frustrated as still nothing done another phone call my daughter in law placed to Humana November 21st see highlighted in yellow for 77 minutes spoke with a representative by the name of Allan who assured me this is not normal procedure and was getting to the bottom of it. He called the doctors office the equipment place while I was on hold for 77 minutes and assured me this would now be taken care of within 72 hours.
72 hours went by still nothing. November 30th my daughter in law called Humana again 3 times that morning 18 minutes 3 minutes and 7 minutes. (highlighted in yellow) Again was told the order was processing.
So what happened to all the calls in November you have not acknowledged.
Called adapt on November
Not the 15 of December as you stated in your reply you are missing the whole previous month prior.
Sincerely,
******* *******Business Response
Date: 02/16/2024
As stated in our previous responses dated February 2, 2024, and February 9, 2024, Humana did not receive an authorization request for a mobility scooter during the 2023 plan year. Humana’s Clinical Intake Team (CIT) did not receive a prior authorization request from Caremax Health for a mobility scooter until January 8, 2024. There is no record in Humana’s system of you calling Humana on November 9, 2023, November 11, 2023, November 21, 2023, or on December 1, 2023. The telephone call placed to Humana on November 30, 2023, by your daughter-in-law was pulled and reviewed. The supervisor stated several times to your daughter-in-law that Humana would need an authorization request form with medical records to begin the authorization process for the mobility scooter. At the end of the call the supervisor informed your daughter-in-law that the authorization request could be initiated by telephone from your PCP and provided her with Humana’s Provider Authorization Line telephone number ************* On February 16, 2024, a detailed resolution letter was mailed to your home address that provides the full details of the call placed to Humana on November 30, 2023.The grievance letter you submitted with your follow-up inquiry under grievance number ************ dated February 7, 2024, states, “Your doctor started the requests back in September 2023, but after multiple tries and multiple DME providers, the authorization was finally approved in January 2024. As stated in our previous response on February 2, 2024, and on February 9, 2024, Humana did not receive an authorization request for your mobility scooter during the 2023 plan year. Humana did not receive a prior authorization request from Caremax Health for a mobility scooter until January 8, 2024. Lastly, Humana does not have access to telephone records from other business entities.Customer Answer
Date: 02/21/2024
Complaint: ********
I am rejecting this response because:
I Cleary sent you the phone bills REPEATEDLY highlighted with YOUR telephone number plus the time spent on the phone that my daughter in law
Leanne Stratton spent a total of 144 minutes between the 4 calls.
I have
sent the whole phone bill this time so there is no question that it is a legitimate
phone bill with her name, account number and the provider of the phone company
that clearly proves she spoke with you on those dates.
Again,
please see highlighted in yellow the dates and times of the phone calls to Humana page 6.
And when
my daughter in law spoke with the supervisor, she already knew Humana needed
the authorization but was assured it was received from the calls made to you prior on those 4 dates you have no record off which I provided and have done so again for a total of 144 minutes of talk with your representatives.. Please keep
in mind Australia is a day ahead of us so those dates would then be a day
behind in the USA So, it would be November 8th 10th 20th.Please see page 6. You CANNOT deny these are your numbers
and Leanne was on the phone with you for all those dates. A total of 144
minutes from those 4 dates.
You may
not have received the request from caremax until January 8th because
that was the third provider to be able to get the scooter but you received it
for the 2 providers prior to caremax.
Please
feel free to call my primary and speak to either Jennifer or Melonie who can
also confirm the amount of times Humana myself and Leanne has called since beginning
of November.
This has
been horrible to do to an elderly person who is alone and suffering with very
little income who is barley able to live.
Sincerely,
******* *******Initial Complaint
Date:01/22/2024
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Humana has not fully paid for my Annual Preventative Care for Mammogram and Bone Density Screening that was done on 4/27/2023, a $230.45 balance remains, with my In-Network Provider. I have spoke to Humana more times than I can count about this claim. They have told me many different stories.
In the 2023 Summary of Benefits, which is attached "coverage", on page 7, it states my plan covers these preventative services at no cost when I see an In-Network provider. The Humana claims department stated that these preventative services are covered 100% with a zero copay.
My bill, which is attached "bill", shows a $230.45 balance, for the Bone Density and Mammogram Screening done on 4/27/2023.
I attached the email, "email", from Humana, dated 12/4/2023, that shows this provider is In-Network, ******* ******* in *******t, **** ***** *** **** ** ********* ** ****** ************. The attached document in the email, **********, shows this provider being In-Network.
The attached document, "inNetwork, shows this provider in In-Network on Humana's website using their search engine.
Humana's claim, attached "claims-detail", states the provider, ******* ******* *******t is Out-of-Network and is denied.
Please correct this and pay the full bill.Business Response
Date: 02/22/2024
Upon receipt of this inquiry, a thorough review of the issue was completed. Your complaint was sent to Humana’s Provider Contracting Department for review and resolution. It was determined that ******* ******* *******t under *** ************** ****** ***** ********* and ******** ******** ********** ***** 1********* was credentialed and contracted with Humana, effective December 1, 2023. Therefore, ******* ******* *******t was an out-of-network (OON) provider on April 27, 2023. Please note: The additional documents that you submitted with your complaint (Email provider listing, Plan- provider details, and Provider network status) are dated December 3, 2023, and December 4, 2023, after the provider became contracted with Humana. Your complaint was then sent to Humana’s Claims Review Unit (CRU) for review and resolution. It was determined that your claim for date of service April 27, 2023, for the services rendered at ******* ******* *******t reprocessed correctly as ONN on May 26, 2023, and paid according to your 2023 plan benefits. According to your 2023 Evidence of Coverage (EOC) on pages fifty (50) through fifty-one (51) your responsibility for a bone mass measurement and breast cancer screening (mammogram) testing rendered at an OON facility is forty (40) percent coinsurance. On February 22, 2024, a detailed response letter was mailed to your address on file. This letter will include plan documents for review.Customer Answer
Date: 02/28/2024
Complaint: ********
I am rejecting this response because: I have sent my response to the Better Business Bureau
Sincerely,
******* ********Business Response
Date: 03/01/2024
As stated in our previous response dated February 23, 2024, ******* ******* *******t under the *** ************** ****** ***** and ******** ******** ********** ***** was credentialed and contracted with Humana, on November 21, 2023, and their contract became effective December 1, 2023. Therefore, ******* ******* *******t was an out-of-network (OON) provider during your visit on April 27, 2023. Please note: There is no documentation in Humana’s system of an outbound telephone call being placed to you on Friday February 23, 2024. It is disheartening to hear about the problems you encountered through interactions with our company. Every one of our members are important. Feedback like yours helps us focus on areas where we can improve our customer service.Customer Answer
Date: 03/10/2024
Complaint: ********
I am rejecting this response because:I have 2 saved voicemails from Humana stating the provider was In Network on April 27, 2023. The calls came in from ************ on 2/23/24 at 1:54pm and 2/29/24 at 2:31pm Colorado time. I have contact with the Humana individual by calling ************. ****** ** ********* ******* is extremely professional, knowledgeable and helpful. To my understanding there was an error with an incorrect number, name or something, that caused the provider to show Out of Network, when they were really In Network. I also understand other customers are being affected as well. It's good to hear this type of feedback helps Humana improve customer service. Thank you for your time.
Sincerely,
******* ********Initial Complaint
Date:01/18/2024
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Earned healthy dollars through Humana Medicare Advantage Go365 for medical tests performed on 12-10-23. Filed online for 2 gift cards totalling $70.00 on 12-13-23. Website indicated order accepted but no follow up e-mail was sent. Previous order also had no confirmation e-mail so I assumed this was normal. Waited weeks for gift cards (process usually takes 3-4 weeks). Finally called 01-16-24 to check status. Spent hours on hold with 4 dropped calls. Was told that the order wasn't processed and I lost the $70.00 I had earned as December 31st was the cutoff to order with no exceptions (despite weekend holiday). I absolutely did order these gift cards and would not have made a fuss if this was indeed my mistake. Very upset because I enrolled in Humana for the perks (dental, vision, and healthy rewards). I am very low income and rely on the healthy rewards as a bonus to buy food and home supplies. Feel that Humana representative and supervisor were rather condescending and basically said so too bad with no solution to address this. I asked for information to file a grievance and the supervisor couldn't/wouldn't even provide this. Since most of my yearly medical tests are done in December, I worry that this may become an ongoing problem. If Humana does not fix this, then I will consider transferring my Medicare Coverage at the next open enrollment period.Business Response
Date: 04/24/2024
please see attached.Customer Answer
Date: 04/25/2024
Complaint: ********It took over 3 months for this company to reply. Humana has the worst communication that I have ever seen in a company and this specific complaint is only a fraction of the problems that I have had with them. They just don't care about customer service. I placed my order mid December 2023, and since it takes weeks to process, I had no idea that there was a problem until the end of year cut-off occurred. Their response was basically to pound sand. Fortunately, I just moved and by law can drop their sorry coverage. I will also leave factual feedback/reviews on any and all forums to warn others to stay away from this company. All for $70.00. Hope it's worth it to them.
Sincerely,
****** *************Business Response
Date: 04/30/2024
Please see attached.Customer Answer
Date: 05/01/2024
Complaint: ********
I am rejecting this response because:This company is so disorganized and will not accept any responsibility for their actions. They continue to respond to this request with numerous duplicate rejection notices long since I quit thinking about it (over a measly $70). That alone says a lot about Humana and not in a good way. That money meant lots more to me on a fixed income than them. Must've have wasted several hundreds as they have sent me several duplicate rejection notices. For that, I am satisfied that they deserve what they get including the negative reviews that they will be receiving from me regarding their service.
Sincerely,
****** *************Customer Answer
Date: 05/01/2024
Complaint: ********
I am rejecting this response because: This company is so disorganized and will not accept any responsibility for their actions. They continue to respond to this request with numerous duplicate rejection notices long since I quit thinking about it (over a measly $70). That alone says a lot about Humana and not in a good way. That money meant lots more to me on a fixed income than them. Must've have wasted several hundreds as they have sent me several duplicate rejection notices. For that, I am satisfied that they deserve what they get including the negative reviews that they will be receiving from me regarding their service.
Sincerely,
****** *************
Sincerely,
****** *************Initial Complaint
Date:11/29/2023
Type:Status:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I ordered 2 bottles Fiberwell Gummies from Centerwell OTC. See the picture shown on their webpage attached. They were $16 each. They sent me some other brand which is higher in calories and contains salt. Their website did not show the brand they sent. If they are going to send a different kind, then they need to state that on the web page. I have been using the Fiberwell Gummies for years and do not want some off brand. I contacted customer service four times and spoke with Managers who said they would help resolve. All I got was that fact they don't take returns and I could reorder. Why would I reorder when they can't guarantee they would send me that the item as shown on the website. This is bait and switch. The product the sent remains unopened. What I want is a refund as I could certainly use the money to purchase the Fiberwell Gummies from a local store.
As you can see by my attachments they confirmation shows Fibewell Gummies and the Shipment documentation shows Fiberwell Gummies. What I got is some YumV's brand.Business Response
Date: 12/08/2023
The response is being sent directly to *** **** due to a valid AOR is not on file.Customer Answer
Date: 12/13/2023
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
Sincerely,
******* *******If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration.Initial Complaint
Date:11/27/2023
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Date of Service January 17 & 18 2023 ******* ********* Four items outstanding totaling $88.50 of which I was reimbursed $64.87. After receiving initial bill for $88.50 in February, called Humana and was told to file for reimbursement. First person sent me the wrong form. Second person couldn't help me and told me I needed to call the facility for further info. By June 22, I filed a grievance and an appeal (tried to attach screen shots). Appeal for the additional funds due me and grievance because of all the errors by phone and a supervisor that was quite rude. Many phone calls later, August 4th I spoke with "********** from Ohio and felt she would rectify my situation. Heard nothing September 25, October 2, October 11, October 17 finally was told by "******* ** Kentucky" that she would refile a new case, #*************. On November 20th was told that if was filed not that long ago and give it time. Really? Couldn't get her to understand how many months and people had passed in trying to work this out. Amazingly, that day I get a letter dated November 9 2023 with a partial explanation. How come people that work there can't see any details or all the interactions I've had? Why so many different stories, lack of consistency and yet I've still NOT received accurate benefits to my plan. UGH! Letter states grievance has been addressed, I am able to appeal the denial, fill out more paperwork, supply things that they already have is what it ends up being. Can't speak with a benefits person that can articulate how this is being interpreted. The sheer phone calls and hours I've spent on this is incomprehensible. No regard for properly doing their jobs or respect for my time.Business Response
Date: 01/19/2024
Upon receipt of this inquiry, a thorough review of the issue was completed. Your complaint was sent to Humana’s Pharmacy Direct Member Reimbursement (DMR) Department for review and resolution. It was determined that on June 8, 2023, you were reimbursed correctly for the medications administered to you on January 17, 2023, through January 18, 2023, at ******* ******* ******* ********. The medications were covered under your Medicare Part D Prescription Drug Plan (PDP) and were subject to copayments and coinsurances just as they would if you had purchased them from a pharmacy. According to your 2023 PDP benefits, you were responsible for $23.63 (Total Amount You Pay), and you were reimbursed the difference in the amount of $64.87 (Amount Paid by Plan). On January 19, 2024, a written resolution letter was mailed to your mailing address on file.Customer Answer
Date: 01/19/2024
Complaint: ********
I am rejecting this response because: There has been no explanation as to $ I owe and why. Benefits should be available to me and how it was calculated. Especially in light of the other meds being covered 100%. This is inconsistent and no one has been able to provide benefit information. Believe this is the least they can provide after ONE year of trying to clear this up.
Sincerely,
****** *********Business Response
Date: 01/26/2024
As stated in our previous response dated January 19, 2024, it was determined that on June 8, 2023, you were reimbursed correctly by Humana’s Pharmacy Direct Member Reimbursement (DMR) Department for the medications administered to you on January 17, 2023, through January 18, 2023, at ******* ******* ******* ********. The medications were covered under your Medicare Part D Prescription Drug Plan (PDP) and were subject to copayments and coinsurances just as they
would if you had purchased them from a pharmacy. According to your 2023 PDP benefits, you were responsible for $23.63 (Total Amount You Pay), and you were reimbursed the difference in the amount of $64.87 (Amount Paid by Plan). According to your 2023 Evidence of Coverage (EOC) under Chapter 5 on page one hundred twenty-three (123) it states, “Other times you can get your
prescription covered if you go to an out-of-network pharmacy: These situations will be covered at an out-of-network rate. In these situations, you will have to pay the full cost (rather than paying just your copayment or coinsurance) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form. If you go to an out-of-network pharmacy or provider, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. We will cover your prescription at an out-of-network pharmacy if at least one of the following applies: If you get a covered prescription drug from an institutional based pharmacy while a patient in an emergency room, provider-based clinic, outpatient surgery clinic, or other outpatient setting.” On January 26, 2024, a written detailed resolution letter was mailed to your mailing address on file that includes the explanation on how you were reimbursed and documents for review.Customer Answer
Date: 01/30/2024
Complaint: ********
I am rejecting this response because: "subject to copayments and coinsurances"? Not once has anyone explained my benefits under my cost responsibility. I don't mind paying for what I owe, but please tell me how you calculate this as the same script (one of them) was covered 100% during that stay.
Sincerely,
****** *********Customer Answer
Date: 02/02/2024
Complaint: ********
I am rejecting this response because: "subject to copayments and coinsurances"? Not once has anyone explained my benefits under my cost responsibility. I don't mind paying for what I owe, but please tell me how you calculate this as the same script (one of them) was covered 100% during that stay.
Sincerely,
****** *********Business Response
Date: 02/06/2024
As stated in our previous responses dated January 19, 2024, and January 26, 2024, it was determined that on June 8, 2023, you were reimbursed correctly by Humana’s Pharmacy Direct Member Reimbursement (DMR) Department for the medications that were SELF-ADMINISTERED on January 17, 2023, through January 18, 2023, at ******* ******* ******* ********. The medications were covered under your Medicare Part D Prescription Drug Plan (PDP) and were subject to copayments and coinsurances just as they would if you had purchased them from a pharmacy. According to your 2023 PDP benefits, you were responsible for $23.63 (Total Amount You Pay), and you were reimbursed the difference in the amount of $64.87 (Amount Paid by Plan). Lastly, there is no record of a medication you received during your stay at ******* ******* ******* ******** on January 17, 2023, through January 18, 2023, being covered at one hundred (100) percent. You were administered intravenous (IV) medications. The cost for the IV injections were discounted by Humana and payment was not required by you or Humana. Exhibit 1 and 2 in your letter mailed on February 6, 2024, contain a copy of your Pharmacy DMR Explanation of Benefits (EOB), the pharmacy claim processing information for each medication, and your EOB confirming that no drugs received on January 17, 2023, through January 18, 2023, were covered at 100 percent.Customer Answer
Date: 02/09/2024
Complaint: ********
I am rejecting this response because: in any of the conversations, documents, etc., what is my responsibility based on copay or coinsurance. I do not believe I have coinsurance and my Humana provided books show I owe $5 for generic 90 day from pharmacy, as an example. Again, I don't mind paying for something I owe but am asking for an explanation and at the very least, one that makes sense as I am your customer and rely on the information you provide." Lastly, there is no record of a medication you received during your stay at ******* ******* ******* ******** on January 17, 2023, through January 18, 2023, being covered at one hundred (100) percent." Excerpt from most recent rebuttal, I have not had any access as to what was billed by ******* (other than EOB) except for the itemized bill I furnished you that shows this information. This is how the whole thing started.
I missed a phone call from ****** Tuesday or Wednesday because I was on another call. Would have loved to speak with her as she indicated that I am receiving another letter dated the 6th that will be a correction. Don't yet have that info so I can't speak to this latest development.
Thank you & Sincerely,
****** *********Customer Answer
Date: 02/14/2024
Complaint: ********
I am rejecting this response because:I am rejecting this response because: in any of the conversations, documents, etc., what is my responsibility based on copay or coinsurance. I do not believe I have coinsurance and my Humana provided books show I owe $5 for generic 90 day from pharmacy, as an example. Again, I don't mind paying for something I owe but am asking for an explanation and at the very least, one that makes sense as I am your customer and rely on the information you provide.
" Lastly, there is no record of a medication you received during your stay at ******* ******* ******* ******** on January 17, 2023, through January 18, 2023, being covered at one hundred (100) percent." Excerpt from most recent rebuttal, I have not had any access as to what was billed by ******* (other than EOB) except for the itemized bill I furnished you that shows this information. This is how the whole thing started.
I missed a phone call from ****** Tuesday or Wednesday because I was on another call. Would have loved to speak with her as she indicated that I am receiving another letter dated the 6th that will be a correction. Don't yet have that info so I can't speak to this latest development.
Thank you & Sincerely,
****** *********Initial Complaint
Date:11/25/2023
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Humana continues to ding me $118.50 for REFUSING to accept my call-in CANCELLATION of 9/14/22, after finally acknowledging my wife's call-in phone cancellation made on SAME DAY, after many mailing harassments, and though she was finally VINDICATED/REMOVED from their harassments, THEY HAVE CONTINUE TO DING ME MONTHLY BY SENDING ME MONTHLY BILLS MADE AFTER MY CANCELLATION, FOR EVERY MONTH SINCE MY CANCELLATION OF 9/14/22, TOTALLING TO DATE OF $118.50 FOR NON-SERVICES, LIKE THEY DON'T HONOR MY PHONE-IN CANCELLATION, JUST LIKE THEY DID WITH MY WIFE ORIGINALLY FOR SEVERAL MONTHS, AND NOW, THEY ARE STEADFASTLY REFUSING TO HONOR MY CANCELLATION, i.e. IT'S NOW BEEN GOING ON FOR 14 MONTHS -- STOP THEIR ELDERLY ABUSE MADNESS!! Both my wife and I have tried UNSUCCESSFULLY to ask ******** to intervene our grievances and still I'm remained to be harassed with monthly bills/invoices for CANCELLED services made via 9/14/22 phone call to their services line. PLS. HELP ME TO STOP THIS MONTHLY ELDERLY ABUSE HARASSING MADNESS, FOR I'M A 86-YR-OLD RETIREE LIVING ON FIXED INCOME, BY STOPPING HUMANA, VIA ******** **** **** **** FROM BILLING ME, i.e. BILLING ID ************** ASAP, THANK YOU.Business Response
Date: 12/04/2023
Upon receipt of this
inquiry, a thorough review of the issue was completed. The complaint was sent to Humana’s
Billing and Disenrollment Department for review and resolution. It was determined
that there is no record of an inbound call from you or your wife to Humana on September
14, 2022. You submitted a document from your cellular phone company that showed
a telephone call placed to ************ on September 14, 2022. However, that was
not evidence that a request was made to terminate your Humana Dental OSB plan. The
first contact Humana’s Enrollment Department received requesting to terminate your
Dental OSB plan was on January 19, 2023, by Humana’s Grievance Department. As a
result, Humana’s Enrollment Department submitted a request to disenroll you from
your Dental OSB plan effective January 31, 2023. According to Humana’s records,
you have a past due Dental OSB premium balance in the amount of $118.50 for October
2022 through December 2022 premiums ($29.20), and for your January 2023 premium
($30.90).Initial Complaint
Date:11/22/2023
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I applied for Humana Gold Plus SNP_DE. My application was rejected. Application ID: ********** There is an error in the rejection letter. One possible reason stated, "You don't meet the age requirement for the ******* full Dual plan."
I do not live in *******. I live in ****. I called customer service. They said it must have been a typo. They did not look into it and wanted me to speak with an agent to get signed up. Since that was wrong, the rejection could have been wrong.
I have had a d-snp since2022. According to my current plan, I am still eligible for 2024. I do not see a reason to be rejected now.Business Response
Date: 12/01/2023
Hi,
Please see attached.
Initial Complaint
Date:11/09/2023
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I filed multiple claims and they refused to pay.Business Response
Date: 11/17/2023
The AOR submitted is not valid. Our response is being sent directly to Mr. *******.Initial Complaint
Date:11/08/2023
Type:Status:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I Had a procedure done at ****** ******* clinic, I had coverage at time of procedure and Humana is not paying ****** ******* for services performed. This has been ongoing for a while I am needing this bill paid by Humana in the amount of 1248.84......Colonoscopy was performed and IS covered under my medical insurance with Humana.. ****** ***** was Doctor Performing procedure for ****** ******* ClinicBusiness Response
Date: 11/17/2023
We did not have an AOR to respond thru the BBB. The response has been sent directly to Ms. *****
BBB Business Profiles may not be reproduced for sales or promotional purposes.
BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.
When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.
BBB Business Profiles generally cover a three-year reporting period, except for customer reviews. Customer reviews posted prior to July 5, 2024, will no longer be published when they reach three years from their submission date. Customer reviews posted on/after July 5, 2024, will be published indefinitely unless otherwise voluntarily retracted by the user who submitted the content, or BBB no longer believes the review is authentic. BBB Business Profiles are subject to change at any time. If you choose to do business with this company, please let them know that you checked their record with BBB.
As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.