29 May, 2019 → by ClaimboUser791023
gold plus (hmo) policy

1

My wife, Patricia A. Nelson member No. H64486787, is having issues with receiving her benefits from the policy. She filed for the policy in December 2018, stating that her birth date was 01/01/1953 and wanted the policy to be in force as of 01/01/2019. Application, as per information of our agent, was lost by Humana. Application was refiled 2 times. On February 1, 2019 she received a letter stating that she was covered as of January 1, 2019. However when she received her member card it states date of issue as 2/1/2019. She submitted an order for over-the-counter med ans products in February. We have not received a conformation regarding that order. She submitted another order in March for the 2nd quarter. Received conformation and finally received a portion of her order. I called regarding this and was told "She is only entitle to $45.00 per quarter and the order was over that." Her policy states she is due $75.00. In speaking to the agent, I found that they did not have her correct information in the computer. My wife's information was mixed with another client who lives in Madison, WV. I connected my agent, he contacted Humana and it was fixed. Then we started receiving EOB and claim denial forms from providers in West Virginia. I called them. They have the correct information for their client. The EOB and denials have wife's Humana number on the. I have now received a claim denial for services provided in Joplin, MO which are valid, but Humana has denied them with this statement "This service is not covered because it was performed after your Humana Health Care Plan had ended". Letter dated May 22, 2019, service date May 15, 2019. I called customer service again today ( call log # [protected] and [protected]) regarding these problems. Again told we will get it fixed. Currently my wife's over-the-counter med orders are on hold until this is fixed. Also need to have the denial of claim to Mercy Clinic in Joplin addressed. We are very disappointed in the service we have received from your company. Today I filed a complaint with the Missouri Department of Insurance regarding your lack of interest in our issues.
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