• Report: #851284

Complaint Review: Humana Gold Plus

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  • Submitted: Fri, March 09, 2012
  • Updated: Fri, March 09, 2012

  • Reported By: Sad Daughter — Houston Texas United States of America
Humana Gold Plus
POBox 14165 Lexington, Kentucky United States of America

Humana Gold Plus HMO control over patients medical decisions Lexington, Kentucky

*Consumer Suggestion: 3rd Party Liability

*Consumer Comment: It's still your mother's decision

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My mother was recently involved in a auto accident and taken to a ICU Trauma Unit in San Antonio. After 12 days in
ICU her Drs. recommended a LTac facility. Humana Gold Plus "reviewed" the Drs. recommendations and disagreed with their request. She was moved to another floor to wait until her chest tubes can come out before Humana will let us know what they will pay for. My mother is in a 3 person room with chest tube, broken hip, open wound, 6 broken ribs, heart problems, broken femur and instead of getting the help that a LTac would be able to provide, she is stuck waiting, against the Drs.
advice, for Humana to see how she progresses. I, her daughter live 200 miles away and  had to return to work after 12 days,(she is stable, just not getting well enough to stand or get tubes out) I offered to pay for transportation to Houston, where I live so that I could be there daily to assist in her recovery and help with decisions. Humana refuses to move her even though the Drs. say it would be best for her to get the care a LTac offers and to be with family. Humana is keeping her there
and making all decisions as to what care she is receiving based on what they will pay for.

My mother pays a good amount to Humana as a replacement for her Medicare thinking that she would receive the best of care. Humana has taken away her right to participate in the decisions of her health care. I would encourage anyone with parents that have Humana Gold Plus to examine other options. Even the Drs. and hospital staff have told me that their hands are tied and they hate to see people come in with Humana because they know they can not give them the level of care that
they need. Medicare is a much better option. Do not let your parents be in the position that my mother is in. Helpless and at the mercey of a review panel deciding what is best for her.

sad daughter
3/9/12 12:02PM

This report was posted on Ripoff Report on 03/09/2012 12:37 PM and is a permanent record located here: http://www.ripoffreport.com/r/Humana-Gold-Plus/Lexington-Kentucky-40512/Humana-Gold-Plus-HMO-control-over-patients-medical-decisions-Lexington-Kentucky-851284. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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REBUTTALS & REPLIES:
0Author 2Consumer 0Employee/Owner
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#1 Consumer Suggestion

3rd Party Liability

AUTHOR: Mandy - (U.S.A.)

Insurance companies often balk at paying much of anything if they believe a 3rd party may be responsible. Was your mother at fault, or was another driver at fault? If another driver was at fault, then your mother should get all the care recommended by the doctor and bill the other person's auto insurance. If the other person's insurance refuses to accept liability, or if the other person is uninsured, she can get an attorney to fight for payment of her medical bills. There are attorneys that specialize in this.

If it's not 3rd party liability, and her insurance won't pay, maybe she can qualify for financial aid through the hospital. Many hospitals have a program for that, but they won't tell you about it. You have to ask the patient accounting department about it.

The best to you and your mom.
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#2 Consumer Comment

It's still your mother's decision

AUTHOR: patti - (United States of America)

You can always sign her out on an AMA (Against Medical Advice).  The hospital just won't take any liability for anything that happens to her.  Humana is not interfering with your medical decisions either. They are just telling you what they will pay for.  You can always pay for it outside of insurance.  
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