Humana Fraud - Georgia Redditors potentially discover widespread insurace fraud in their state's division of Humana

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Now this is a story all about how my life got flipped-turned upside down and I'd like to take a minute, just sit right there - I'll tell you how I got screwed by Humana Healthcare.

My wife and I have been a Humana customer for years on a high deductible plan self-insured and we had our first baby born earlier this year in February.

For years we paid all of our medical expenses out of pocket because of the high deductible plan (which is fine - we preferred that over paying the higher monthly premiums because my wife and I are in good health overall).

The day our baby was born I called Humana to add our child to our policy. This is where our relationship with Humana went south.

We had no special medical issues with our kid or my wife and went home within a couple of days. About a month and a half later, at a visit at a dentist, I'm trying to find our dental policy number by logging in to Humana's website.

We have both medical and dental plans with them.

It's important to note at this point we are a highly digital family and we make sure to use and set email and phone notifications for anything we can. This is why we had opened the online account with Humana so we could easily pay online, get status updates, track expenses and payments, etc.

While logging into the website I saw a notice in one of the internal pages that the policy has been terminated. I figured 'that's odd'. I'm clicking through the Medical plan area and the same notice appears there.

I promptly call customer service and ask why has our policies been terminated. To make a long story short - apparently when they added my kid to the policy, they also marked the policy to be terminated by customer request - WTH.

The rep told me he'll get back to me and indeed he did after an hour or so and confirmed that this was a mistake and he submitted my policies to be re-instated and it would take a few days but it would be retroactive to the missing period.

I figured - 'well, s*** happens, but they made it right so ok'. He told me I had to re-add my payment account online (we used our credit card) because once the policy was terminated it also stopped any billpay.

The policy was reinstated a few days later, I went online and added our credit card again, they billed it for the missing period and everything was fine and back to normal.

As the months went by we continued using different healthcare providers for our baby and my wife (standard treatment stuff - vaccinations, wellness exams, etc) and the providers sent the bill to Humana claims as normal and whatever bills we had to pay during the deductible amounts came home and everything was fine.

Fast forward to the last week of June I can two letters in the mail from Humana.

One of them with brand new cards dated June 10 and another letter with an invoice dated June 16 with Payment Due July 1 showing $1953.51 due.

I figured that's odd. Looking at the invoice, it looks like we had 2 billing periods due + the upcoming one for July.

I logged in online to see what's going on, and I saw indeed there is a balance due of $1,953.51 as well. I'm looking at the payment accounts and the credit card is nowhere to be found - only an option to add a bank account.

I then go to the deductibles/claims area and I see it's showing a 0/$6,500 for my wife - also thought that was off since of course the bills from the birth were well over the deductible amount.

I call Humana to inquire about the deductible issue and the due payments.

I explain the situation and saying I got an invoice today with so and so to pay and I logged in, didn't see our credit card, had the issue with the deductibles not showing, etc - in short, explained I want to pay it and make sure all our deductibles are in place.

It's important to mention here - at no point in time in our life did Humana pay out anything for us because we've never hit our deductible and we didn't have any special events at this point in time besides our child's healthcare needs which, have their own $6500 deductible that started from scratch when he was born.

The lady on the phone proceeds to tell me that she sees our coverage has been terminated since APRIL 30 2016 because of no payment.

She continued to tell me that Humana sent out a letter in March saying they no longer accept credit card payments.

Of course - no registered mail or any proof on their end that a letter was sent or received. Apparently that's good enough when you cancel somebody's payment method for their primary health care policy.

I told her not only I never received such letter, I continued to receive regular mail for statements from Humana every month including this most recent letter that I'm staring at dated June 16 2016 with a due date of July 1 AND I have BRAND NEW CARDS PRINTED JUNE 10 2016.

I didn't yell - I know the difference between a customer service rep and the monster machine that created this scenario.

She told me that there's nothing she can do on her end but she can transfer me to the claims department that have more power on stuff they can submit.

While waiting for a new rep to come on the line, I checked my email to see if I received any emails about the payment account issue just to make sure and sure enough - I didn't.

The new customer service rep comes up, I explain the history and she proceeds to check the account.

At this point at least she did confirm that our deductible had hit its max amount and the claims are counted at over $7,000 for my wife. I figured at least when we figure this out we finally won't have to pay for stuff to her this year and finally enjoy the benefits of having health insurance - yay.

She says that the policy was terminated because no payments were received and it was cancelled to reflect the last date they got paid for (basically for April - back in March, when they cancelled our insurance and I had to re-setup our payment account with a credit card and pay it).

I explain this entire story again and she says the only thing she can do is file an appeal on the phone. We start doing that - had to explain the chain of events from scratch while she is typing the appeal.

We finish, she submits the appeal, gives me a reference number and tells me I'll be contacted within 5 business days. This was just before July 4th so I figured it might take longer.

A week later (July 7) I get a piece in the mail from Humana dated June 17th as evidence of termination (how convenient that it's dated a day after the last mail I got dated that says I owe them money to be paid in July).

I call today (July 12th) to check what's going on and the customer service rep tells me there was a decision made on the account on June 29th (!!!!) and they decided not to reinstate my account.

Mind you - we've been a paying customer for years, never once had them actually pay anything because we never hit our deductible and my entire request was just to pay them because of their issue of not telling me about the credit card payment method issue so my family can be insured again.

Interestingly enough, the first time in the business relationship with Humana that they're actually poised to pay anything, we get our policy cancelled and not willing to re-instate although I have plenty of hard paper evidence of continuous communication from them that does not suggest in any way our account is not in good standing or that our account was terminated.

I ask the service rep what recourse do I have - she says 'at this point if I re-submit another appeal they will just deny it'.

I continue to ask her if I can apply for coverage with another healthcare provider and she says only if I had a qualifying life event in the past 60 days otherwise I have to wait until the next enrollment period at end of year.

So this is where I'm at. Out of coverage and lost all of our deductibles for this year for the first time ever we used them in full.

What would you do? Who would you complain to?

How is it possible that a healthcare company can send you policy
terminating communications without any method of delivery confirmation for proof?

Did this happen to anyone else?

Von meinem iPhone gesendet

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