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Message
This Month's Insurance Debacle - Humana Prescriptions
Posted on 6/1/16 at 11:35 am
Posted on 6/1/16 at 11:35 am
A few months back my wife's purse was stolen with her medication inside the purse. Her refill for this medication was 4 days later. The theft took place during a long holiday weekend for which the doctors office was closed already and would not be open until the refill date. She spoke with her pharmacist who understood the situation and filled the script early and we paid out of pocket.
I filed the claim with Humana and it was denied because Humana does not cover lost or stolen medications. However, we specifically asked them only for reimbursement of the portion 26/30 (87%) that was filled correctly. Humana states that we were to get the 4 pills filled separately. When I asked how she was to get a replacement script filed for a needed medication when the Dr.'s office is unavailable, they had no answer.
What a shitty way to do business and lack common sense.
I filed the claim with Humana and it was denied because Humana does not cover lost or stolen medications. However, we specifically asked them only for reimbursement of the portion 26/30 (87%) that was filled correctly. Humana states that we were to get the 4 pills filled separately. When I asked how she was to get a replacement script filed for a needed medication when the Dr.'s office is unavailable, they had no answer.
What a shitty way to do business and lack common sense.
3
Posted on 6/1/16 at 12:00 pm to Golfer
quote:
What a shitty way to do business and lack common sense.
Humana is one of the nastiest and greediest of the major health insurers. Several years ago my uncle, who lives in Florida, collapsed at his grandson's wedding in Houston. He was rushed to the hospital and eventually diagnosed with advanced kidney cancer. While lying deathly ill in his hospital bed in Houston, Humana tried to cut him off because he was out-of-network. They actually told him to get on a plane and get back to Florida so he could be treated at one of their in-network hospitals.
Posted on 6/1/16 at 1:26 pm to Golfer
Could the pharmacist not just have split the orders in two?
Posted on 6/1/16 at 2:05 pm to LSUFanHouston
quote:
Could the pharmacist not just have split the orders in two?
Split what? It's one 30-day script that was filled 4 days early.
Didn't ask because I've never heard of this being done until you mentioned it, but I guess I'll know for the future. Nor did they offer. This was a Wallgreens so I'm not surprised on that end.
Posted on 6/1/16 at 2:54 pm to Golfer
You need to file an appeal with Humana. If you are persistent you will get it paid. It will likely cost you more in time spent than the out of pocket you stand to get back, but sometimes it's the principle of the situation.
Posted on 6/1/16 at 3:00 pm to BR Tiger
Thanks. I submitted the second appeal letter this morning. And we're already at that point as the initial appeal letter was denied because it was more than 30 days past the denial letter, which was sent to our old address that we haven't lived at in over 16 months and have changed it with Humana more than once.
Posted on 6/1/16 at 3:03 pm to Golfer
I understand why you did what you did.
I would have asked for a 34 day fill - 4 days replacement and a regular 30 day refill. The pharmacist should be able to replace lost medicine. I'm sure there is some process involved - maybe contacting the doctor on call - but they should have done this. Of course you would have had to pay for those 4 pills.
I would have asked for a 34 day fill - 4 days replacement and a regular 30 day refill. The pharmacist should be able to replace lost medicine. I'm sure there is some process involved - maybe contacting the doctor on call - but they should have done this. Of course you would have had to pay for those 4 pills.
Posted on 6/1/16 at 3:04 pm to Golfer
Oh, and let me say that as of today, our company's health insurance switched from BCBS to Humana... so this is not wanted to see today. =(
Posted on 6/1/16 at 3:07 pm to LSUFanHouston
quote:
I would have asked for a 34 day fill - 4 days replacement and a regular 30 day refill. The pharmacist should be able to replace lost medicine. I'm sure there is some process involved - maybe contacting the doctor on call - but they should have done this. Of course you would have had to pay for those 4 pills.
Yeah, hindsight we would have done this. I knew we were going to pay out of pocket for the 4 stolen from the beginning, but I guess I thought some common sense would take over when the reimbursement request came in. According to the supervisor I spoke with recently, they automatically deny any claim when the word stolen is mentioned.
Posted on 6/1/16 at 3:35 pm to LSUFanHouston
quote:
Oh, and let me say that as of today, our company's health insurance switched from BCBS to Humana... so this is not wanted to see today. =(
I've got BCBS, but my wife has Humana. I do have to say Humana's EOB and Claims information online is much better than BCBS. But their customer service related to claims is sub-par.
Posted on 6/1/16 at 5:22 pm to Golfer
Humana....run away, run away, run away and do not look back..the worst carrier I deal with
Posted on 6/2/16 at 9:22 am to wfallstiger
Damn Golfer, y'all need to move south of the border and enjoy that magnificent universal health care bro.
Posted on 6/2/16 at 1:25 pm to iknowmorethanyou
Hell no. 
Posted on 9/12/16 at 11:03 am to BR Tiger
quote:
You need to file an appeal with Humana. If you are persistent you will get it paid. It will likely cost you more in time spent than the out of pocket you stand to get back, but sometimes it's the principle of the situation.
Bump. Second Appeal was denied. Apparently now they are telling us all we had to do was call them ahead of getting the script refilled.
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