Complaint Review: Humana - Fort Worth Texas
- Humana 1300 Summit Ave.Ste 811 Fort Worth, Texas U.S.A.
- Phone:
- Web:
- Category: Health Insurance
Humana Health insurance did not pay second guess doctor Fort Worth Texas
*Consumer Suggestion: I have to respectfully disagree.
*UPDATE Employee: Try this.
*Author of original report: Thank you for the response
*Consumer Suggestion: Rx
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I had an infection on my hand. My doctor (a specialist) gave me a prescription. Humana would not pay for it without pre-authorization, which would take a week. I needed the medication NOW because it was getting worse, so I paid for it out of my pocket. I had had this infection for a long time and had already been seeing the doctor for a while. Everything he tried up to this point did not work.
A week later, Humana denied it because they said it was the wrong medication for the infection. Guess what? The medication worked and it went away. Those idiots are saying that my doctor does not know what he is doing. They are wrong!
The bottom line is I pay them for health insurance. If my doctor says I need a medication, they have no right to deny it. Those morons are not doctors! I am changing health insurance in January. Humana is worthless. WORTHLESS!
I have NEVER had trouble with any other health insurance in my life. My empolyer changes insurance every couple of years, so I have had insurance from a LOT of different companies over the past 15 years.
You owe me money AGAIN Humana!!!
David
Seguin, Texas
U.S.A.
This report was posted on Ripoff Report on 12/23/2007 04:04 PM and is a permanent record located here: https://www.ripoffreport.com/reports/humana/fort-worth-texas-76102-4420/humana-health-insurance-did-not-pay-second-guess-doctor-fort-worth-texas-294069. 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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#4 Consumer Suggestion
I have to respectfully disagree.
AUTHOR: I Am The Law - (U.S.A.)
SUBMITTED: Friday, July 18, 2008
Claims people ARE actually medically trained. I'm glad it worked for you, but even if a medication is FDA approved, it may not be universally used for other types of conditions. (Using it for purposes other than intended and all that.) I'm not trying to take sides, but Humana was right to deny that claim and that information is expressly written in your certificate.
#3 UPDATE Employee
Try this.
AUTHOR: I Am The Law - (U.S.A.)
SUBMITTED: Monday, April 21, 2008
Write in for a grieveance. Address is: Humana Health Plans. PO BOX 14546 Lexington, KY 40512-4546. I imagine that the denial was from the fact that the medication being used is actually for a different area of the body, but I'd have to look at the claim to be sure. The denial is stemming from the fact (most likely) that Humana thinks your doctor is misbilling or perhaps even trying to pull a fast one on them. Not saying that he is, but I can see this from Humana's perspective, too. Good luck.
#2 Author of original report
Thank you for the response
AUTHOR: David - (U.S.A.)
SUBMITTED: Monday, December 24, 2007
The medication is FDA approved for this type of infection (fungal). The problem is, the infection was on my thumb and the medication is used for infections of the foot. They denied it because of the location of the infection. My doctor called them and they still would not pay. The drug is on their prefered list also.
#1 Consumer Suggestion
Rx
AUTHOR: Jim - (U.S.A.)
SUBMITTED: Sunday, December 23, 2007
Did your doctor request allowance for the medication from Humana. Doctor can request but it is not always 100%.
Here's one possible problem, did the medication have FDA approval to treat infection? Most health insurers won't cover a medication for any use other than FDA approved treatments. For example, some doctors use a cancer pain medication for migranes. Works great however FDA has not approved it for that use. Rx plans won't cover it unless it is for the intended FDA approved use.
If the medication is approved that you took (for infection), is it then a non-formulary medication with Humana? Does your health plan have tier 3 level Rx benefits for non-formulary brand?
Best thing to do if it is FDA approved is to have your doctor contact Humana and request an exception for use of the medication. Often contracted physicians can get approvals for non-formulary meds for patients if they can demonstrate the medical necessity of the drug over other options.
BTW, you can file a grievance with your health insurer to reconsider and provide documention from your doctor with that. Those will be reviewed by real doctors at the health insurer.
Good luck on this but certainly you should appeal to the health insurer.
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