Report: #250410

Complaint Review: Humana Gold Plus

  • Submitted: Fri, May 25, 2007
  • Updated: Mon, April 21, 2008
  • Reported By: none Tennessee
  • Humana Gold Plus
    PO Box 33008
    Louisville, Kentucky
    U.S.A.

Humana Gold Plus Ripoff Said my Prescriptions were covered and then denied them Louisville Kentucky

*Consumer Comment: Claims v. Facts

*UPDATE Employee: Here's what's going on.

*Author of original report: Humana Gold Plus Tennessee

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Sonny Culver came to my house to sell me a Humana Gold Plus Insurance. I asked if my Doctor was covered and he said, She is not listed, but there would not be a problem with getting her to sign up. I asked if my TWO prescriptions were covered and he looked them up and said yes.

When I had the first prescription filled I got a letter in about three days saying they had denied it because they felt it was not good for me. I called the insurance man and he said I have never had this happen. He said there was nothing he could do about it. I called the Humana Drug office to find out why and they didn't know. They told me to call my Doctor and get it taken care of. That was about a month ago and I still don't have an answer. Who died and left them in charge of my prescription.

So I thought you know I had better check and see what Mr. Culver did about my Doctor. So I made an appointment. When I got there and gave the girl my card she said OH we don't take this. I was furious. I saw the Doctor anyway and she explained why they didn't take that insurance. No problem, I got a new Doctor that is suppose to be covered. We will see if I get another letter.

Second prescription. I called Humana to make sure it was covered. I was told yes and I said are you sure. The girl said yes and went to check, came back and said no problem. So I had the prescription filled. This is not a cheap drug.Then I got a letter in the mail saying they have denied this prescription because they didn't have enough information. I'm sorry, but this is just a lying company and I hope no one else ever ever takes one of these policies. Talk about a Rip-Off, Humana is at the top of the list.

So what gives this company the right to deny what I need.
I have already been through other drugs and they didn't work or caused hives. So when your Doctor finds ones that work or help the insurance company should honor her/his request. The Doctor didn't go to school all those years for nothing. I don't see Humana going to school to be a doctor or a pharmacist

They lied
none, Tennessee
U.S.A.
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This report was posted on Ripoff Report on 05/25/2007 02:31 PM and is a permanent record located here: http://www.ripoffreport.com/reports/humana-gold-plus/louisville-kentucky-40232-3008/humana-gold-plus-ripoff-said-my-prescriptions-were-covered-and-then-denied-them-louisville-250410. 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. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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REBUTTALS & REPLIES:
0Author
3Consumer
0Employee/Owner

#1 Consumer Comment

Claims v. Facts

AUTHOR: Disavowed - (USA)

Just because someone claims that their employees have specific training does not make it true. And if every employee has medical training, that does not prove their competency. Anyone can take a basic first aid class and claim to have medical training but that would not qualify them to the a surgeon. Even if they had completed medical school, would you trust someone who barely passed more than someone who has a license to practice medicine?

All medicines have a degree of risk involved. Even taking an over-the-counter drug, such as Tylenol, carries some risk. Normally, a doctor looks at the individual patient, their complete medical history, and makes a decision as to whether or not there is a risk with an individual drug. Does Humana's employees have the qualifications and the entire medical history of the patient to make a determination as to whether or not the risk of taking this drug outweighs the risks of not taking it?

As it is, at least where I am, a doctor takes into consideration the risks of prescribing a specific medication to a patient. In addition to this, the pharmacy also reviews the medications, and even compares them with other medications, to verify that there are no dangerous interactions.

Are we expected to believe that a Humana employee has the qualifications of either a Doctor (M.D. or D.O.) or a pharmacist? Do they have access to all of the necessary information?

Finally, who is the individual taking the risk? Does the doctor, pharmacist, or Humana employee take the medicine? Are they at risk if something happens? I do not believe so. It falls on the end user/consumer to take the medicine or not. If they are in severe pain or have disabling side effects, they may even be willing to risk their lives in the chance that it may improve their condition. What right does Humana have to step in and determine what this individual should do or not do?

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#2 UPDATE Employee

Here's what's going on.

AUTHOR: I Am The Law - (U.S.A.)

First of all, Humana's claims reviewers are medically trained. If they feel that a drug is bad for you, trust me, they have the expertise to say so. Those claims go through multiple levels of review, so it's basically several people against your doctor. Ever think that maybe your doctor is in the wrong? No, of course not. It's just easier to point your little finger and scream about how evil a company is without researching the situation.
Second of all, you can't blame Humana if a doctor doesn't want to contract with them. What do you want them to do? Maybe bring in some armed thugs into the doctor's office and threaten the doctor with violence if they don't sign up? You're talking about letting the doctor make some choices, but you neglected to realize that it's their choice to do business with whatever insurance carriers that they want.
Third of all, if your provider didn't send the required information to Humana to get the perscription filled, why are you wondering why they denied it? Why don't you pick up your little phone and call Humana and do a three-way call with one of their reps and the doctor? That would certainly take less time than bad-mouthing a reputable company on the internet, wouldn't it?
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#3 Author of original report

Humana Gold Plus Tennessee

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

I have finally been disenrolled from the Humana Gold Plus plan. Thank you Medicare for all your help. I hope no one ever signs up for Humana Gold Plus. All they do is lie to you.
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