Humana Health Insurance - Wrongfully Denied My Greivance Against a Hospital on a Technicality, and Failed to Do a Through Investigation Based Upon Facts and Evidence Lexington Kentucky

HUMANA is a Medicare Advantage Plan which I had since January 1, 2024.  From my horrible experiences with them, over these past 18 months, I can only conclude that HUMANA is IN BED with Hospitals and Medical Professionals.

True, they offer a way to file a GREIVANCE against the hospital or medical professional, but the real truth, is they will give your greivance ZERO CREDIBILITY AND WILL LOOK FOR ANY EXCUSE TO DENY LEGITIMATE GREIVANCES.

Then, they offer you a way to APPEAL THEIR DENIAL OF THE GREIVANCE, BUT THEN THEY DISMISS THE APPEAL ON A STUPID TECHNICALITY - LEAVING THE PATIENT/CUSTOMER MORE FRUSTRATED THEN EVER.

Also, most of the people, who take your phone call are NOT from the USA.  Most are not able to speak English in an understandable way.  The result is endless phone calls, long wait to speak to a supervisor or anyone else.  Also unsolved problems. Decisions NOT in the patient's favor.

My position here is validated due to the MANY, MANY ONLINE COMPLAINTS AGAINST HUMANA on the Better Business Bureau, and other internet forums.

My own experience has been going on Since early Janaury 2025, when  the Aspirus Hospital did the wrong CT Scan on me.  I was not able to resolve the problem with Aspirus, no matter how high on the Management Scale I went.  I always believed that one should try any and all means at their disposal to first try to mediate and resolve issues and problems with the principals - which in my case is Aspirus Hospital.  After 6 full months of trying, and getting the shaft from Aspirus,  I did file a Greivance with Humana.

I made the mistake of THINKING THEY WOULD BE ON MY SIDE SINCE THEY HAD TO PAY THEIR PART FOR THIS WRONGLY DONE CT SCAN.  NOPE!  I WAS WRONG.

BEFORE I BEGIN, THIS FRUSTRATING STORY, I WANT TO GIVE ALL OF YOU FOLKS OUT THERE THE FIRST NAME OF THE PERSON WHO HAS CAUSED MY BIGGEST FRUSTRATION.

Her name is CHANTEL IN TEXAS.  CHANTEL IS SUPPOSED TO BE A "PATIENT HEALTH ADVOCATE IN THE GREIVANCE AND APPEALS DEPT."

Well, I can say only this:  IF CHANTEL IS MY ADVOCATE, AND HAS BEEN SO HORRIBLE AND UNCARING TO DEAL WITH TODAY, WHEN SHE IS SUPPOSED TO BE SUPPORTIVE OF ME, I WOULD HATE TO MEET MY ENEMY.

WITH ADVOCATES LIKE CHANTEL, ONE WOULD NOT WANT TO MEET THEIR ENEMY IN THIS CASE.

I did file a detailed greivance, after I could not work things out with Aspirus Hospital.  I took alot of time and energy carefully detailing everything the hospital did wrong to me and all my efforts to resolve the problems, which failed because Aspirus Hospital Staff and management were uncaring and cruel toward me, a 75 year old woman.

The greivance was filed and faxed on June 6, 2025.  On June 17, 2025, less than 2 weeks later, I get a computerized FORM LETTER FROM HUMANA STATING THAT THEY ARE DENYING MY GREIVANCE because it was past 60 days.

I guess Humana did not read the content of the greivance because they would have known the vast amount of time I spent trying to resolve the problems with the hospital.

I also do not believe they even read my greivance!  IT SEEMS TO ME THAT THE HUMANA COMPUTERS ARE ONLY LOOKING AT A DATE OF SERVICE AND WHEN ONE FILES THE GREIVANCE.

NOW HEAR THIS!  I DID NOT KNOW ANYTHING ABOUT A 60 DAY TIME PERIOD.  NO ONE IN HUMANA TOLD ME ANYTHING ABOUT 60 DAY TIME LIMIT EVEN THOUGH I HAD CALLED THEM MANY TIMES TO TELL THEM WHAT WAS HAPPENING.

THEN MY INSURANCE LADY, HELPED ME FILE AN APPEAL.  I filed and faxed the appeal on June 23, 2025 and then found some compelling evidence in my favor.  I spoke with Danielle M. - another Patient Health Advocate, and she encourged me to fax directly to her the evidence I found.  I did that on June 27, 2025.

WELL, LOW AND BEHOLD, TODAY, JULY 8, 2025, I GET IN THE MAIL ANOTHER COMPUTERIZED LETTER, DATED JULY 2, 2025 DENYING MY APPEAL.

HOW IN BLAZES CAN HUMANA READ AND UNDERSTAND TWO FAXED APPEALS ONLY 5 DAYS AFTER THEY WERE SENT???????  YOU TELL ME?

TODAY, JULY 8, 2025 IS WHEN I HAD A HORRIBLE, AGRIVATING AND FRUSTRATING PHONE CONVERSATION WITH

CHANTEL OF TEXAS.

This woman was the most uncaring, condesending, and horrible person I have worked with at Humana since I first joined them.

She had absolutely no sympathy for my situation.  She was too stupid to understand the fact that I tried, for a long time to work things out with the Hospital - but to no avail.

She only kept talking over and over again sayting the same thing THAT YOU DID NOT FILE THE GREIVANCE WITHIN 60 DAYS FROM OCCURANCE.

I told her over and over again, that I did not know anything about a time limit.  Even my insurance agent did not tell me about any time limits.  How was I to know this.

This terrible woman, CHANTEL, tried to put the entire blame for this on me and not the hospital.  She did not care one bit about all the terrible experiences I had with the Aspirus Hospitals.

She humiliated me, made me feel bad and did not validate anything I said.

THIS IS WHY I FEEL THAT HUMANA IS 'IN BED' WITH HOSPTALS AND MEDICAL PROFESSIONALS.  THEY HAVE THEIR BACKS, NOT THE PATIENT'S BACK.

Now I have to file more complaints with more State and Federal Agencies, just to get the same bad treatment, where my complaint will be TRIVIALED, TOTALLY IGNORED AND DISMISSED OUT OF HAND.

Tomorrow, I am going to speak to my insurance agent, who sold me the Humana Plan and try to get her liason to go to bat for me.  I do not know what to expect.

I guess my next greivance is now going to be against HUMANA, SINCE THEY SEEM TO CONDONE HAVING A HATEFUL, UNCARING PERSON - CHANTEL - FALSELY PRETENDING TO BE A PATIENT HEALTH ADVOCATE.

Due to the problems with the Aspirus Hospital and now Humana, my health condition with my jaw has gotten much worse and may now need surgery.

But I am quite sure Humana does not care about this.  After all, the Hospital and Humana are BUDDIES.

If there is anyone out there, who has also had bad experience with HUMANA aka HUMANA/MEDICARE, kindly offer some help here or share your own experience.

Signed,

IF YOU THINK YOU HAVE PROBLEMS WITH HOSPITALS, DOCTORS, ETC, YOU WILL FIND YOUR PROBLEMS MULTIPLY - TO THE POINT - OF A NERVOUS ANXIETY - ONCE YOU FILE A GREIVANCE WITH HUMANA!

Experienced and worse off now!