Wednesday, February 12, 2014

I won't recommend
Humana Advantage
Because . . .

Exercise in customer DISservice.

This is my first, and very likely my last, year as a Humana Advantage client.

A little background.

For the last several years I was covered by an AvMed Advantage program.

While there were a few bumps in the road, I generally was satisfied with AvMed and had planned a long-term relationship with the provider. Good for AvMed, good for me.

However, AvMed "delisted" my long-time Primary Care Physician (PCP), leaving me with the option of

  1. Finding a new PCP
  2. Changing Advantage providers
  3. 1 and 2, above
AvMed didn't provide a reason to delist my PCP's practice - maybe it was because as good as the medical staff is, the administrative side is … suffice it to write that it "leaves a lot to be desired."

Patients need an on-going relationship with their doctors; I had that with mine. I credit him with saving my life by correctly and promptly diagnosing an abdominal aortic aneurysm; both of my parents died of aneurysms.

I wrote above that the AvMed road was not always smooth. But AvMed did have customer service; moreover, clients could email, snail mail, or phone AvMed executives - their contact information was provided on each AvMed newsletter.

I took advantage of that information on several occasions; AvMed always responded promptly.

For all that, I was miffed that AvMed cancelled my PCP.

So I went with the second option: I looked for a new Advantage plan that listed my PCP.

I checked several plans, none of this compared favorably to AvMed.

Now I was at Option 3 - find a new Advantage plan and new PCP.

Again, I checked multiple plans.

Humana was cost effective - in some areas better than AvMed (lower specialist co-pays, break on mail order prescriptions). Not an appreciable difference - perhaps $200 over the course of a calendar year.

Humana also listed both my specialists.

So I signed up with Humana.

And then I got a surprise.

Just because a practitioner is on Humana's provider list does - surprise - NOT mean any Humana PCP can refer a patient to that specialist.

My soon-to-be former Humana PCP informed me that my specialist, although on Human's practitioner list was not on his Humana-approved list; he could not get me an authorization to visit my long-time ophthalmologist.

As with a PCP, patients need to develop a relationship with their doctors - Humana, while on one hand promising me my doctors had contracts with Humana denied me a referral to that doctor.


My about-to-be-former PCP told me I have two options:

  1. Go to a specialist on his Humana "approved" list
  2. Find a new PCP.
No brainer - find a new PCP.

But, there's a catch. I was told, by the PCP and later by Humana, that the client (me) had to contact each prospective PCP and ask the PCP('s office) if the PCP could refer to all my specialists.


I asked Humana to tell me which of four prospective PCPs I listed could refer me to my two specialists.

No response.

I asked again.

For the second time (I previously asked an unrelated question three times before I got a response) I got a message telling me "Sorry, we've been busy."

If Customer Service is so busy, why doesn't Humana increase staffing? Is image of no importance? Has Humana so many clients it can afford to antagonize them with such cavalier treatment? Apparently.

The secure email from Humana in response to my second try re PCP vs. Specialists apparently was created by a person who flunked First Grade reading. Not only was my query unanswered, but the correspondent sent me a list of possible PCPs, none of which was named in my missive to Humana.

AvMed has its problems, but AvMed - unlike Humana - takes Customer Service seriously. When dealing with health issues, I want issues dealt with the first time. Humana fails miserably when it comes to Customer Service.

If I was trying to buy something and asked the seller's CS folks a question and failed to get an answer, I'd simply find another product.

Unfortunately, with Medicare, I'm "locked in" to Humana for the duration of 2014.

I feel lied to by Humana.

    Yes, we list your specialists.

    No, you can't see your specialists because you selected a PCP who cannot refer to them.

    Oh, we didn't tell you about the restrictions? Sorry, we were busy.

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