Wiki Humana - Is it just me

[andersont]

Is it just me or has anybody else had issues with dealing with Humana, whether it be claims or authorizations? I am beyond frustrated. I can't even speak with a supervisor as I am sure they do not have one. Does anybody know who I could speak to to voice my frustrations and concerns? Preferably someone that can be understood. Thanks

 

[danachock]

Humana Woes

Hi, I really felt the need to reach out. I feel your frustration and pain. I currently have a claim that I am battling with them and they are denying it stating I have provided a secondary diagnosis code when in fact it is a principal diagnosis code. I have several resources plus the aid of my ICD 9 book to support it. Unfortunately some the reps can be down right horrible, the attitude, the willingness to assist, even the broken English can be a horrible barrier we have to face. I know that asking for a supervisor won't get you anywhere - when I call and feel my options have been exhausted and my blood pressure may be elevated I politely end the call.
Get a call reference number, the name of who you spoke with, and the date with time. I usually allow 24 hours but depending on necessity may call them back sooner.
When I am calling back I usually have already prepared new/different questions to ask. I usually start with "Hi, my name is Dana calling with xxxx health company. I had called yesterday on this claim and I have a few more questions; would you mind reviewing it with me please?" Have your information ready. They are probably looking at a computer monitor and the notes from their coworker that made notes from yesterday. Also make sure you have your EOB(s) pulled up with the adjustment codes they applied handy. There have been other insurance providers I have practiced this scenario on. Always remember to keep your cool & be polite and with maybe a few extra phone calls you will be on track to tackling some of your denial questions.
Hopefully some of this will help,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB

Ps. I don't deal with the authorization part of this - but I love appealing something especially when that type of information was provided by someone from Humana and they denied it with "prior authorization wasn't granted." I usually just print off the sheet that states who from our facility received permission at what time, date, and for which procedure and corresponding diagnosis codes.

 

[dpaine01]

Hi, I also feel your frustration. I have been transferred to a supervisor but had to wait on hold for close to 30 minutes to speak to one -- and their english wasn't any better. I did actually take the survey once to express my frustration. The person who called me back didn't speak english very well either and seemed to think the problem was limited to one individual. I tried to tell her it wasn't just one person -- it was everyone I spoke to but I'm not sure she really understood. I also have a hard time now because Humana is doing take backs on payments issued over 3 years ago. When you call and the rep. sees it's a take back they stop giving you any information. It's like hitting a brick wall. Then you have to call the Provider Integrity unit, leave a message, and if you're lucky someone will call you back in a couple of days. But don't count on them calling back. My call back rate is about 50%. Then after taking the payment for the entire claim back I'm told the claim is too old to adjust or repay! So we're SOL.
I try to be polite and make multiple calls like Dana suggested but I don't seem to get anywhere.
Sorry I can't help -- but I can commiserate.
Dawn Paine, CPC, CMIS

 

[syllingk]

Contact your provider service representative with Humana.

 

[psd]

Humana = Ridiculous

I am sooooo frustrated with Humana. I have all of your problems and then some. It seems like they hired 10000 people to deal with the ACA influx but didn't train even one of them, just gave them a phone and a fake English name. Lately I have to write a letter for everything, they can't even reprocess a claim without me having to explain it. I was even told by Provider Relations that we don't have a provider rep and they acted like I was crazy for asking. So. Over. This. They probably waste at least 5 hours of my time a week with their bogus refund requests and denying claims because they don't look at provider specialty. Grrrr