Humana Insurance Beware of inflated "Participating Doctors" lists Nationwide Nationwide

I agree with Franzg for once. If an insurance carrier doesn't have a huge presence in a particular area, I would advise going with another carrier. No sense in your out of network benefits being your only option.

Seems like a good idea to have your physician tell you what would pay your doctor bill. Better than enrolling in a plan like Humana with no doctors in there area. Now that's dumb.

Seems like a good idea to have your physician tell you what would pay your doctor bill. Better than enrolling in a plan like Humana with no doctors in there area. Now that's dumb.

Seems like a good idea to have your physician tell you what would pay your doctor bill. Better than enrolling in a plan like Humana with no doctors in there area. Now that's dumb.

Seems like a good idea to have your physician tell you what would pay your doctor bill. Better than enrolling in a plan like Humana with no doctors in there area. Now that's dumb.

So you want your doctor to shop around for the patient? I won't even comment on how dumb that comment is....

So you want your doctor to shop around for the patient? I won't even comment on how dumb that comment is....

So you want your doctor to shop around for the patient? I won't even comment on how dumb that comment is....

I would ask a doctor you trust which plan to use. I would not trust what a managed care company tells you as far as benefits and participating physicians.

It is bait and switch marketing.

As for working for managed care, you would have to be a fool to do so. Humana can't even seem to take care of their own clients.

I would ask a doctor you trust which plan to use. I would not trust what a managed care company tells you as far as benefits and participating physicians.

It is bait and switch marketing.

As for working for managed care, you would have to be a fool to do so. Humana can't even seem to take care of their own clients.

I would ask a doctor you trust which plan to use. I would not trust what a managed care company tells you as far as benefits and participating physicians.

It is bait and switch marketing.

As for working for managed care, you would have to be a fool to do so. Humana can't even seem to take care of their own clients.

Franzg works for a health insurance carrier. I have his business card. It's colored bone white and the font is Silian Rail.

Yes, all of us.

$640 billion a year. For a system which is confusing, and not accepted by many doctors.

Yes, I believe managed care has had their chance. It is now time for managed care to admit defeat and step down.

For "I am the flaw" maybe this would help-

Aetna stinks.
BC/BS stinks
Humana stinks
United Health stinks
All HMOs, PPOs, Medicare part D plans stink
etc..., etc..., etc...

Feel better now?

Franzg, I don't see why you keep saying that managed care should be eliminated since you work for a health insurance company. Wouldn't that just put you out of a job?

If you have a better solution than health insurance to solve the health care crisis, I'm all ears.

No, if you actually read the post (assuming you understand english), I did not say "I want to eliminate the insurance companies so providers will be free to do things like charge $50,000 for a routine physical"

I said eliminate the managed care model.

It is a joke, it is wasteful, and it is fiscally irresponsible. It also needs to be bailed out.

I say 3 strikes, you're out. Managed care needs to go away, so we can get medical care.

We need healthcare, not this managed care nonsense.

So, you're saying you want to eliminate the insurance companies so providers will be free to do things like charge $50,000 for a routine physical? Smart, man, smart.

Open a complaints department. One with a phone #. And get rid of hired bloggers. They drive up the cost of Humana health insurance.

Pay out of pocket for whatever you can afford.

Get insurance for what you cannot.

Eliminate the middleman (managed care), and let supply and demand take care of it. (like it does everything else in a free market economy).

Allow consumers to use well respected physicians in their areas if they choose to do so. Even if the physician does not want to deal with your beloved Humana.

Do not keep managed care going. It does not provide healthcare, it is a burden on the taxpayers, and is unnecessary to have in our free market economy. Sorry I don't believe in the "managed care model".

Apparently Franzg gets his kicks from arguing common sense. Ok, Franzg, if you're such a high and mighty know-it-all about healthcare, I challenge you to answer this one question: What is your answer to managed care? Paying out of pocket? That's dumb. If you're so quick to criticize my insurance carrier, why don't you suggest how you'd fix the health care crisis in America? Like my mother used to say "If you don't have anything constructive to say, don't say anything at all."

The list of participating providers for large insurance companies is quite misleading, and is a common problem. Many physicians are refusing to accept insurance such as Humana because it is difficult to get paid for delivering quality care for the clients. It is not being lazy-just intelligent.

Humana's little shell game with plan providers and covered services is not illegal, but it is quite unethical. A physician who is in network with Humana must jump through many hoops to get the proper care covered for their clients. A physician can only get reimbursed for procedures authorized by Humana. As a result, the physician is forced to administer cheaper procedures which are not as advanced or safe as our technology is capable of. The physician is also forced to initiate older, cheaper, and less effective prescription medications. Of course Humana and its team of administrators and lawyers ensures that this practice is legal. The physician is left with the liability of the outcome of these cheap, outdated practices.

That is why more and more physicians refuse to accept Humana insurance.

I agree that clients would be wise to ask their physician about the best course of action in choosing a plan to pay for health care. The quality of your health care should be between client and physician, since the client wants to get well, and the physician is liable for their wellness. Humana is just a meddling middleman in this particular case.

The key to understand when calling ANY Dr is to ask "Are you a participating Dr with Humana" not just "do you take Humana?" as well as "Are you accepting new patients as a participating Dr with Humana?"

I worked right next to a team that all they did was call members and Dr's offices to establish IF they were considered exsisting patients. Most members would list a Dr's office that they had never been to and would be denied because they were not established.

There sounds like there is much more to your story than what you are giving as you are talking about seeing "specialists" which may not have been included in the specific plan you chose and signed with.

And reading any EX employee comments that worked in a comission based area makes me laugh regardless of what company it was for. Humana is a top company that is under contract and working with Medicare. Fly by night companies or "outfits" are not contracted and accepted by the government such as Humana is.

Just a quick response to the above Anonymous post: It sounds like you have a PPO. It also sounds like the facility you went to might be out of network. (I'm guessing) In a case like that, what your insurance carrier would pay to an out of network provider (or attribute towards your deductible assuming you have one and it hasn't been satisfied) is called the usual, customary, and reasonable rate. (UCR for short) What this means is that this is an average for that service in that geographic region. Now, health providers, just like any other merchant, vary in price. Some are cheaper, some are more expensive. If the one you went to is a bit pricier than others in the area, yes, you can be balance billed and there's nothing Humana can do about it. Understand without a contract in place, your insurance provider can't control the facility's pricing.
The same logic applies to auto insurance. If you total your car that you bought for $15000.00 and the fair market value is $10000.00, then you have to take that loss.

Tom, I've had sort of similar problems with Humana that I have been trying to get resolved for 4 months without success. I had an ER visit back in March 2008 and was billed for a level 5 visit by the provider (the bill was over $500). Humana processed the claim as in-network, stating that the provider was a contracted provider on my Explanation of Benefits. Humana paid the provider around $130, and their "maximum allowable charge" for the visit was around $165, leaving me with an estimated responsibility of $35.

However, the provider says they do not have a contract with Humana and has been billing me for $450 ever since March. I've called Humana's customer service line 15 times so far and have written two letters to Humana with copies of my EOB and the provider's bill enclosed. Every time I call, I get a different story about whether Humana does or does not have a contract with the provider, and a different story about how Humana will investigate the problem and how long it will take to get an answer. To this day, they have been unable to locate the specific contract and call the provider to straighten out the situation.

Meanwhile, I'm being threatened with a collections agency for this $450 bill. It's unbelievable to me that this company cannot give me an answer to a simple yes or no question after 4 months, and that they claim that the provider is contracted, but can't find the contract! Pretty incompetent. So it's possible that what happened to you is an extension of this same type of problem--the company is incapable of maintaining accurate, up to date records of its own contracts!

Becki, I'm just trying to tell people what's going on behind the scenes and trying to give them the inside track. There are obviously some participating oncologists and dermatologists in that area, they just refuse to file claims with Humana. That doesn't mean that those providers are not participating with the patient's plan; it just means that those doctors are lazy and want to shove that responsibility off on the patient. Unfortunately, the insurance carriers can't predict that the provider will want their money upfront. I see that quite alot and frankly, those providers are making more work for themselves because most of the time that means the billing department has to send out a refund to the patient after the insurance company makes a payment to the doctor or hospital. I have dealt with Humana claims in my job for a long time and all they require to reimburse the patient is a proof of payment and the medical documentation from the provider (with the CPT codes, diagnosis codes, etc. etc. on it.) They don't even make you fill out one of those complicated claim forms which is nice. I'm sorry the doctor you've been seeing for those fifteen years decided not to contract with Humana, but that's hardly their fault. Providers sign up with and drop insurance carriers constantly; that's why Humana has several ways to check if a provider is participating or not. This is not "bait and switching" and clearly they have a large network considering they are a Fortune 500 company.

You did everything and more that you could have done. You are absolutely right when you were saying to this "I am Law" character who rebuttals every comment made about Humana (by the way) that it's not your job to play a liason, its Humana's job to make SURE they are giving their members correct information. This "law" person wants to make them blameless to every situation! WAKE UP! Its an insurance company, and its human beings on the phones and on the systems, has he ever heard the term :" To be human is to error". I saw it every single day, hundreds of times in a day, my co-workers would give people all kinds of wacky answers, that wwere just flat out WRONG, did I go to my Managers and let them know the false info. that was being dished out? YOU BET! Did they ever do anything about? NOPE! I witnessed an associate, using "scare tactics" just to get one of our seniors to do an in home appt. so that he could collect the commissions, he'd give them all kinds of falsified info., In fact, he still does, they don't care, whatever is oing to get them the almighty DOLLAR, is all that matters to that place! Now, don't get me wrong, this "I am law" person may work in a more professional atmosphere than I did, who knows, but to make comments on everyone's complaints as if Humana, does no wrong is just ignorant, evryone, every company, etc. makes mistakes, no one is error proof! You are very smart to be looking elsewhere. You might want to check with the Dept. of Insurance and the BBB to check credibility on certain companies before choosing. Just a thought.
Good luck with all of your future endeavors.

Invirgina-
Thank you for the information. My situation with Humana does not involve Medicare (I am only 44). I simply have a problem with a bait and switch technique in Humana's advertising themselves as having large doctor networks in my area (West Michigan), but phone calls into the doctor's offices proving otherwise.

I Am The Law-
I appreciate your angle of doctors often running multiple tax ID numbers for tax, licensing, and liability purposes, but I feel as a consumer, it is not my place to become a laison between Humana and the "contracted" service provider to secure this information and demand adherence to any agreement entered into by the provider and Humana.

Perhaps doctors change tax ID numbers as often as Humana changes claim procedures - ie: PPOM has become Cofinity, yet PPOM's Michigan address is still listed on the back of Humana's "Claim denied form" even though they are no longer part of the Humana network. Humana's rep on the phone this week told me I "couldn't possibly be reading that correctly - all our new computer systems are set up to route through Cofinity" Yeah, I had just pulled that notice out of my mailbox Monday.

Bottom line -

I'm shopping again and will be much more careful with my next carrier -

Invirgina-
Thank you for the information. My situation with Humana does not involve Medicare (I am only 44). I simply have a problem with a bait and switch technique in Humana's advertising themselves as having large doctor networks in my area (West Michigan), but phone calls into the doctor's offices proving otherwise.

I Am The Law-
I appreciate your angle of doctors often running multiple tax ID numbers for tax, licensing, and liability purposes, but I feel as a consumer, it is not my place to become a laison between Humana and the "contracted" service provider to secure this information and demand adherence to any agreement entered into by the provider and Humana.

Perhaps doctors change tax ID numbers as often as Humana changes claim procedures - ie: PPOM has become Cofinity, yet PPOM's Michigan address is still listed on the back of Humana's "Claim denied form" even though they are no longer part of the Humana network. Humana's rep on the phone this week told me I "couldn't possibly be reading that correctly - all our new computer systems are set up to route through Cofinity" Yeah, I had just pulled that notice out of my mailbox Monday.

Bottom line -

I'm shopping again and will be much more careful with my next carrier -

Invirgina-
Thank you for the information. My situation with Humana does not involve Medicare (I am only 44). I simply have a problem with a bait and switch technique in Humana's advertising themselves as having large doctor networks in my area (West Michigan), but phone calls into the doctor's offices proving otherwise.

I Am The Law-
I appreciate your angle of doctors often running multiple tax ID numbers for tax, licensing, and liability purposes, but I feel as a consumer, it is not my place to become a laison between Humana and the "contracted" service provider to secure this information and demand adherence to any agreement entered into by the provider and Humana.

Perhaps doctors change tax ID numbers as often as Humana changes claim procedures - ie: PPOM has become Cofinity, yet PPOM's Michigan address is still listed on the back of Humana's "Claim denied form" even though they are no longer part of the Humana network. Humana's rep on the phone this week told me I "couldn't possibly be reading that correctly - all our new computer systems are set up to route through Cofinity" Yeah, I had just pulled that notice out of my mailbox Monday.

Bottom line -

I'm shopping again and will be much more careful with my next carrier -

Medicare advantage plans are new and alot of doctors are not familiar with some of the companies. These plans are helpful , seniors that cannot pay for supplemental insurance thru aarp etc. because original medicare only pays 80% .
These plans eliminates the 20% you normally have topay you only have to pay a min copay. We need to educate some of these dr.s to accept these medicare plans thru private insurance. One day all doctors will have to accept all Medicare Advantage plans. These plans are worth it because you are not paying additional premium and you are not paying 20% of all bills. In regards to Humana , they cannot control doctors. you haveto work in the system and use the doctors that accept the coverage till you particular doctor starts losing clients and starts accepting Humana. These plans are paid by medicare and your social security income that is taken out every month so I recommend using it because you have paid for it. Tell these doctors to get with the program because sooner or later everyone with medicare will be on these plans like humana

Not to argue, but you're saying that one of the largest insurance companies in America has only a handful of doctors in their network? If that were true, they wouldn't be one of the largest insurance companies in America. Look, participating or non-participating status depends on the tax id of the provider providing the service. We can tell you if a provider is contracted with Humana or not, (so can those other resources mentioned before.) but we can't predict what is going to be on a claim. It may come in under a completely different provider name. Also, understand that some doctors and facilities are sporting multiple tax id's, some may be contracted, some may not. So, what I'm saying is if that claim comes in with tax ID 123 and the only one with a contract with Humana is 789, then, yes, it was deny as a non-participating provider. It should. There is frankly nothing Humana can do about that. We can ask them to rebill, but we are at the provider's mercy whether they want to do that or not. Humana does offer a dispute process for any claim you feel wasn't paid correctly. Call them for details.

I stand by my original comment that the number of "participating" providers is indeed inflated. Just as recommended by "I Am The Law", I had utilized both Humana's web site as well as their 1-800 service number to proactively locate "participating" health care providers. Humana's call center responded that they can not be held responsible for physicians listed on their web-site. Yes, I also communicated with Humana the list of physicians who would not work with Humana. With the exception of one dermatologist who was thrown in federal prison last fall (I had attached a copy of the Grand Rapids Press front page detailing his sentencing - Humana subsequently removed him), the rest are still on Humana's "participating" list on their web site.

In making reimbursement claims for my family doctor (claimed as a participating physician both on line as well as verbally through Humana's call center), Humana has denied these because the physician is deemed "out of network".

I stand by my charge of inflated physician networks.

Tom
Grand Rapids Mich

I'm sorry, but I have to disagree completely with your statements. Humana is one of the largest insurance companies in the United States. Humana offers members multiple ways to determine if a provider is participating or not. The Internet is the best source, but a provider directory can be requested as well. They have a customer service line (800-448-6262) that is open until 8pm EST that can also confirm provider participation. Now, they can confirm the provider's status, but if the provider is willing to take the time and fill out a claim form and file with Humana; there's no way to predict that. Some providers want the patient to do all that work. So, that isn't Humana's fault. In addition, it's been my experience that most providers have little knowledge about who they've signed contracts with, so my advice is to check with Humana directly. As for Humana, "just randomly picking physician names out of the phone book to put on their list", I can't even fathom why you'd think that. To say that that would be fraud would be a gross understatement. Trust me, there is no hidden agenda at Humana.