Why I am Leaving Humana
Posted in the Humana Forum
#1 Mar 26, 2010
Since selecting Humana Prescription Coverage in 2007, I have been ordered two prescriptions by my doctor. Both have been denied by Humana. The first was for a specific cholesterol medication; I have simply told my heirs if I die of a Christal related illness they should sue the pants off of Humana. 2nd was for Tussionex cough syrup in February. It also was denied. I paid for the medicine, and asked for a review. Humana sent the appropriate form to my doctor, who completed and returned the same day. I followed up apx a week later, was told by customer service the prescription had been approved and they would send to pharmacy. I explained I had already paid for and was using the medicine. CS sent me a reimbursement form to complete and return. I complied. Today they denied AGAIN saying "Duplicate Claim."
This is absurd. I have been on the phone with Humana for over an hour today, transfered several times, placed on hold for a cumulative 40 minutes, and still no resolution.
Do you think this is the only forum where I will voice my dissatisfaction?
#2 Mar 26, 2011
A series of labs done in September 2010 was denied by Humana sticking me with a $500.00 bill. This has been under review by Humana since December and I received notice today that they have again denied the claim. I have had cancer twice since 2001. If they do this to a cancer patient how do they treat other policyholders.
#3 May 11, 2013
Tussionex is not a maintenance medication and is not for that reason a life or death type of drug. It is a cough syrup (like a liquid Vicodin). It is liquid Oxycodone plus an antihistamine added. It is a potent cough medicine and very addictive, and very much abused (as most opiates are) for cough suppresion, and it also comes in generic form. Tussionex as brand, probably cost about $8/once but the generic version is about 35 cents per ounce. However, Tussionex has black market value as it sells very expensive in the illicit drug diversion black market (very addictive). Generic version do not. Most insurance companies do not cover drugs that are "black market" targets. It is actually illegal to support and encourage the use of these drugs. Your doctor is not supposed to be giving you a highly addictive cough syrup like that in first place, with a high black market value, subject to street diversion, and should be giving you the generic alternative instead. It will probably be also a non-coverable drug version too, but at least more affordable than the brand Tussionex. If there is a duplicate claim issue, you are over-utilizing the drug as per DUR. You already took the drug few days ago, and are getting it again "too soon". Being a narcotic it will be impossible for anyone to dispense it too soon without breaking the DEA law. The pharmacy can loose the license if so. The insurance company can be fined also by the DEA. You are placing the prescriber in license jeopardy (perhaps with your doctor shopping behavior), the pharmacy (perhaps with also a multi pharmacy shopping behavior), by over utilizing the narcotic, and as a result jeopardizing their licenses. This breaks the law! In most states, patients like that are arrested with multiple DEA charges. In many cases, felony charges are for 10 years jail for doctors shopping charges alone. Hope you are not diverting the drug, this will add 10 more years if arrested.
#4 Oct 29, 2013
They told me they wouldn't pay on three of my drugs because they were consider narcotic.
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