Friday, February 7, 2014

Humana Advantage plan

Customer DISservice

Why is it that more and more often, "customer service" is more akin to "customer disservice."

I'm a "geezer" - it beats the alternative - and I have Medicare via a Medicare Advantage plan. Financially, it's a really good deal so from a cost perspective I have no complaints.

I had AvMed for for several years and was less or more satisfied with it.

For the 2014 calendar year, AvMed

  (a) cancelled my Primary Care Physician (PCP) and
  (b) raised some of its copays albeit not egregiously.

Why AvMed cancelled my PCP's practice is between AvMed and the practice - although the practice's administration services might be the reason; the medical side was better than good - not so the admin side.

My choice then was

  (a) stay with AvMed and find a new PCP,
  (b) sign up with a different Medicare Advantage provider that had a contract with my PCP's practice, or
  (c) get a new provider and a new PCP.

There was a fourth possibility: sign up with a Medicare Supplement program; that would allow me to go to any practitioner who accepted Medicare, but that was an expensive option.

Bottom line: I checked a number of Advantage plans in my area and, after talking with several providers and checking on-line plan summaries of even more providers, I settled on Humana.

According to Humana's Web site, except for my PCP, it had all my doctors, in practitioners and facilities:

  General surgeon (Dr. Brett Cohen),

  Ophthalmologist (Dr. David Goldberger),

  Vascular surgeon (Dr. Jeffrey Hertz), and

  Hollywood Regional (nee Memorial) Hospital

Even better, the copays were less than AvMed.

So I became a Humana Medicare Advantage - perhaps DISadvantage is more accurate - client.

And then the fun began.

Both AvMed and Humana required referrals; Humana calls them "pre-authorizations." Not a problem.

I went to my new Humana PCP, who shall remain anonymous, and asked for a referral to my vascular surgeon for a one-year anniversary follow-up after an open AAA. It took Humana about a week to permit the referral. Not like the faster turn-around with AvMed, but this is Humana.

My PCP told me that he would not request a referral to my ophthalmologist until I had my eyes checked by an optometrist. That would be reasonable except my ophthalmologist is listed by Humana as a practitioner who does refractions. As a matter of fact, Eye Surgeons & Consultants, Dr. Goldberger's practice, is listed first on the page of people/organizations qualified by Humana to do refractions.

Humana recommends a couple of optical service providers. I took the one nearest me (still much father away than Eye Surgeons & Consultants). The OD who examined (and impressed me) said I needed to see an ophthalmologist about my developing cataracts - one of the reasons I wanted the appointment with Eye Surgeons & Consultants in the first place.

The OD sent his report to the PCP. I stopped by the PCP's office and gave the office staff two pages photocopied from Humana's provider book - unlike AvMed, Humana neither numbers its pages nor provides provider ID with the practitioner's name and address, making it hard to tell someone to "See Page nn" or "The practitioner ID is nnnnn" to aid in identification.

That evening the new PCP called - credit where it is due - and told me Humana gives him a list of practitioners to whom he can refer patients. Dr. Goldberger was not on this PCP's list; sorry, but I cannot be referred to my long-time ophthalmologist.

My options, the PCP told, me were two:

  1. Go to a ophthalmologist on the PCP's list

  2. Find a new PCP

The PCP explained that if I insisted on specific providers, I should either

  a. Contact the specialist and ask which Humana PCPs referred to the practice or

  b. Contact each potential PCP and ask them if they were able to refer to the selected specialists.

In 3 words: NOT MY JOB.

I accessed my Humana account and found "Contact Customer Service." It was a message form. Pretty standard.

I sent Humana my request on Sunday:

"Please tell me which PCPs can refer to the following specialists and facilities."

I know that Humana's customer service probably is closed on the weekend.

Today is Friday, a full week of "business days" and I have yet to hear from Humana's customer service. On Day 4 (Thursday) I snail-mailed a letter to Humana's customer service. Maybe that will generate a response.

Meanwhile, as Humana's approved OD pointed out, my cataracts are getting ripe and, unless an ophthalmologist decides it's time to operate, I need a new Rx for lenses. I can't do anything until Humana responds to my question.

My complaint is not only that Humana has so far failed to provide the information I need, it is more that Humana listed my specialists in its providers list and that greatly influenced my decision to buy the Humana plan. I don't understand why ANY PCP is restricted from referring to ANY practitioner listed in the providers list.

AvMed used to have someone monitoring the WWW for mention of the word "AvMed"; when a complaint or kudos hit the Web, AvMed knew it and acted on it. Hopefully Humana will do likewise.

It's customer service truly is customer DISservice and I am not a happy camper.

Humana, are you listening?

No comments: