Elderly complain about Humana Medicare Advantage payment delays
ST. PAUL — Elderly Minnesotans across the state say Humana Insurance Co. is delaying payments and just not paying their claims.
“I am concerned that if these practices continue, Humana will take advantage of other vulnerable senior citizens that are not able to stand up for themselves,” Marie Brewster-Christy, 70, of Grand Rapids said.
And Mary Ann Anderson, 71, of Granite Falls added: “Even after Humana corrected some of my claims, it continued to bill me incorrectly for others.”
The three examples are among 27 that Attorney General Lori Swanson sent to federal officials Friday asking that action be taken against Humana to help Medicare patients.
“Medical bills that aren’t covered or processed properly can hit senior citizens hard in the pocketbook,” Swanson said. “We are asking the federal agency that has authority over these plans to fully investigate and remedy the problems experienced by Minnesota patients.”
Humana did not immediately respond to a request for comment.
Complaints involve Humana’s Medicare Advantage plans that replace Medicare coverage and add more benefits.
In her letter to the U.S. Department and Health and Human Services, Swanson claimed Humana had improperly denied claims, overcharged for co-payments, failed to clearly show what medical providers are in an insurance policy’s network and did not follow federal requirements.
Federal law does not allow Swanson to take action against Humana in state courts, but her office has written letters to help Minnesotans who feel cheated.
A Swanson spokesman said more people have complained than those represented in the 27 affidavits.
Health care providers say they do not have as many problems with other Medical Advantage insurance companies.
Humana is one of the largest providers of the policies and Minnesota has by far the most people of any state carrying such policies.
Dawn Kern of Bigfork Valley Hospital, Clinics and Community in northeastern Minnesota’s Bigfork gave two patients of examples of problems she has faced with Humana.
She said both patients had obtained preauthorization from Humana for home care services, but claims of $7,000 in one case and $1,700 in the other were denied because the insurer said it never gave preauthorization.
“For the next two years, my department spent countless hours trying to get Humana to pay...” Kern said.
She said her staff has made 24 calls to get paid for one patient’s services and 27 for the other, without results.
“Humana denies claims for routine procedures that are unquestionably covered by Medicare,” Kern said, indicating that a Medicare Advantage plan should cover everything Medicare covers.
In New York Mills, Brenda Boyne of Elders’ Home and Heritage Manor tells a similar story.
In one case, Boyne said, Humana blamed another company for denying payment. Later, she said, she discovered that the other company was a Human subsidiary.
“I am exasperated by the time I have spent appealing Humana’s wrongful denials,” Boyne said.
Anderson, the 71-year-old Granite Falls woman, told of paying a $10 co-pay every time she saw her health-care provider in 2010. The next year, without a change in her plan, Humana said she owed $30 for each visit.
Humana would not pay a $698 ultrasound bill when Anderson experienced lightheadedness and other issues because the procedure “was not reasonable or necessary.”
After the attorney general’s office became involved, Anderson said, “Humana admitted that based on the medical record, this ultrasound was reasonable and necessary and paid this claim.”