Humana sucks!

Wow. My experience in that same program has been reasonably good up to this point. A family member did have a TIA (mini-stroke) and was hospitalized for two days. There were no problems. (Hospital billing was an eye opener.) When I did have a coverage question I went staight to OPERS, NOT Humana. Things were resolved quickly.

All their coverage is stated pretty explicitly in their coverage manual. I wouldnt think that OPERS would renew a plan (it did renew Humana Medicare Advantage for 2012) if there were many serious substantive complaints such as yours.

I'm really sorry you have had such a hard time with this. I hope you let OPERS know what happened.

I wish your mother well too. A stroke is no fun.

The Hub is going on it thru PERS in April. He's in excellent health, so I hope we have no problems. Mom in law is also on it thru PERS. I'm sure she would call me if she had any questions or problems and I've heard nothing, even after an out-of-state ER visit. I'll ask her. Sorry about your mom's problems, BD, it's always the ones who need problems the least that get them the most.

Not to hijack this thread or turn it into a political debate but this is just one of so many horrible and inhumane stories that result from a for-profit health care system. It's terrible that insured Americans are treated this way and even more horrible how the uninsured are treated.

It makes me sick (no pun intended) that people profit from the poor health care of others. All the best to your mother in this unfortunate situation.

If you look them up on Medicare.gov's health plan compare function for 2011 plans, you'll see they had a big red warning sign on that plan indicating that it had received low ratings from Medicare for 3 years in a row.

Walleye I have gov't healthcare and I'd trade it for private in a heartbeat.

I had to wait 6 months for a surgery while my brother had the same one a few years later and had to wait a month. He had Aetna as his provider while I had Tricare.

Extra bonus, I got to drive and hour and a half for my surgury passing 3 major gov't hospitals that Tricare wouldn't let me go to because my Primary Provider, who I never met and who never saw me, wouldn't sign off on it.

The grass isn't always greener on the other side.

mom2 - Thanks for that posting. I'm going to write to OPERS and ask why they chose Humana in light of those warnings.

Holland - it does appear that the warning has been removed for 2012. So, perhaps they have addressed and taken corrective action on some of the issues?

(Which doesn't really help the people who had problems in the past of course, but may be ok going forward?)

Thanks for the update mom2. It still leaves me uneasy. Common sense says they made only the minimum changes necessary to get the warning removed.

"I'm really sorry you have had such a hard time with this. I hope you let OPERS know what happened.",

Thanks, Holland. My mom worked hard her whole life, and always came home after a hard day's work to be a great mom to her kids - playing with us (she was a big kid herself, lol), getting food on the table, doing laundry, etc. Never complaining. We are so fortunate to have such a great mom (as everyone here would probably say about their moms). She never let me down, so I'm not going to drop my appeals and stop fighting for her. Very time consuming, though.

"It makes me sick (no pun intended) that people profit from the poor health care of others. All the best to your mother in this unfortunate situation."

Thanks, WalleyeWinger. My sentiments exactly regarding the exploitive nature of health care insurance companies. At least as it relates to the problems my mom's had with Humana.

The main problem my mom has had is that Humana dropped her coverage for skilled nursing just four days after her stroke, saying that her progress had "plataued," and they also dropped her physical and occupational coverage. I guess they expect you to tap dance out the door after four days of brain trauma! Both of her appeals that I had filed for her were denied. Now I have to go before an administrative law judge and plead my case for my mom.

I guess the biggest thing that I have learned about Humana is how every nurse, doctor and the administrator at the skilled nursing facility have all told me how restrictive Humana is when interpreting coverage and how they are the worst. My mom's user handbook promises up to 365 days of skilled nursing coverge, but apparently that's to get you to buy their plans, I guess.

Anthem Medicare Advantage is a good provider, in my opinion. $59 per month in 2012 and that includes drug coverage. No issues that I know of. I haven't been hospitalized, but my brother has, and he also had some very expensive tests ($90,000 range), and they paid with no difficulty.

Bikerdude - to be fair, the "up to 365 days of skilled nursing" only applies when the patient meets skilled criteria as defined by traditional Medicare.

No Medicare plan - be it regular Medicare or the other health plans - covers skilled nursing for a patient that doesn't meet skilled criteria.

It is possible (and wouldn't surprise me a bit) that the plan was very strictly interpreting the Medicare criteria. But, in general those same rules apply to all Medicare patients.

"It is possible (and wouldn't surprise me a bit) that the plan was very strictly interpreting the Medicare criteria. But, in general those same rules apply to all Medicare patients."

That may be true, but it doesn't make it right (not criticizing you, mom2, but Humana). If Humana is strictly interpreting Medicare criteria, and terminating coverage for stroke patients after just four friggin days, it's pathetic!

A very good friend of mine had a huge issue with Humana. Her mother was in a coma for two months. TWO months. COMA..PRONE... She wakes up, says a few words, is able to dangle her feet some, and was receiving physical and speech therapy. She was dropped by Humana within a week of miraculously coming out of a coma for skilled nursing care because Humana decided that she was not making progress. Now, I am NO doctor but common sense seems to take over here.. From silent and prone to talking and trying to move her feet seems to me to be progress.
As for WalleyeWinger... Well said! The whole system is broke and run by money hungry idiots!

I'm way too young to know this much about original Medicare versus Medicare Advantage Plans like Humana, but it is a real eye opener researching this for my mom.

http://www.elderlawanswers.com/resources/article.asp?id=6247§ion=4

Please post when you have had your hearing with the Administrative Law Judge. After visiting the web site you linked hopefully it be done quickly within the mandated time frame.