Opuscula Humana web: Bad directions Ruin experience

I AM NEITHER A COMPUTER GURU NOR AN INTERNET NOVICE.

I AM spoiled having been a technical writer for more than a few years, writing — among other things ‐ how to use a web site. I always validated the instructions before releasing them “into the wild.”

I’M BACK WITH HUMANA’s Medicare advantage plan — second time around — and already I’m unhappy with the company. We are “stuck” with each other “for the duration” than runs until 12/31/2019.

You might justifiably ask, if I was sufficiently disenchanted with Humana in the past to leave it, why did I return?

Two reasons.

It has my specialists on its roster AND I found a PCP who claims he is willing to refer me to those specialists.
It is more cost effective than the only other Advantage plan I considered, AvMed. AvMed overcharges for my medications.

Humana, as many Medicare Advantage plans, offers Over The Counter (OTC) medications. The dollar amount Humana covers varies by the subscriber’s address.

Anthem’s Simply Medicare Advantage plan’s OTC order process via the WWW was straight forward. Unfortunately, Simply had too many disadvantages for me to stay with it.

Log in, go to the OTC page, select the products, confirm client information and done.

My first experience with Humana’s OTC site was frustrating.

First of all, instructions are wrong. Users are told to go to a linked page and click on a specific title.

The link does NOT go to the page and when he user finally gets to the page, the title is different. Not by much, but “enough.”

 
BY-THE-NUMBERS WAY I “DISCOVERED”

 

In looking for something else (How to Contact Humana) I “discovered” the easy way to get to the OTC page. Sign in. Select My Profile in the gray banner at the top of the page, then select any of the drop-down menu options. When the page is displayed, scroll to the bottom of the page under the green Humana bar. Find > Tools and resources then click on Humana Pharmacy Mailorder Rx When a new page is displayed, scroll down to the green bar under Humana Pharmacy and click on Shop Products near the right side of the green bar. Select Over-the-Counter (OTC) items from the drop-down list. See following images.

 

 

 

 

Humana, obviously in an effort to make life simple for its clients presents its OTC products by category. Click on an icon and see what’s available in that specific category.

Simply, on the other hand, also categorized, but in one long list.

Making life as difficult as possible, Humana fails to allow uses to search for a product. Users may select High or Low price, but searching for a specific product is not available.

 

Screen capture of a Humana OTC category page. Note no “Search” option.

 

Interestingly, there are products listed on Humana’s paper document that are not available to the on-line form. The OTC offering, like the formulary offerings, is “subject to change.” Worst case, I can go to a local outlet and buy the product on my own. The product may show up on next month’s OTC offerings.

The OTC benefit is nice, and Humana must offer it to be competitive; Medicare Advantage is a highly competitive — and lucrative — business, especially in areas with large geezer populations.

Humana has one more deficiency.

Customer Service.

A client can call Customer Service.

A client can mail a paper letter to Customer Service.

A client cannot email to customer service.

Subscribers (clients) CAN “chat” with a Humana representative.

Unfortunately, only email provides a two-way multi-exchange communication history in one file.

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Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

BCPLANNER: Comments on Humana

Unhealthy insurance Humana and its docs Raise my blood pressure

 

I'm frustrated and my blood pressure, already high, is going to stratospheric levels.

Why?

Glad you asked.

I am a geezer on Medicare. My Medicare Advantage provider is, until December 31, 2014, Humana, specifically Humana Gold Plus (HMO).

My PCP is Leung Healthcare, a multi-office practice in Florida's Broward and Dade counties.

I signed up with Leung after my first Humana PCP refused to refer me to my long-time ophthalmologist who is a Humana practitioner. That boggled my mind - a Humana PCP refusing a referral to a Humana specialist.

IN ANY EVENT, last week I visited my PCP's office. I gave the office folks two pieces of paper.

One piece was a form from RightSource, the mail order pharmacy that contracts with Humana. The instruction was very clear - order ONE 30-day supply with two refills (total 90 day supply) of a specific medication. RightSource normally sends all 3 months in one package.

The other piece of paper instructed, in 14 point text that I needed three (3) separate, individual prescriptions for three additional medications. Each script (prescription) was to be for a 30-day supply plus two (2) refills for a total of a 90 day supply. I take the three meds I wanted prescribed on separate prescription blanks to local pharmacies; two of my medications are free from Publix, a local high end supermarket.

OK.

Leung's sole doctor - the nearby office is advertised as a two-physician practice, but this has not been true since early 2014 - has twice managed to mess up my meds. For that and other reasons I now avoid the practitioner and see a "certified" physician's assistant. In Florida, a physician's assistant is not required to be a registered nurse (RN). It's bad enough when a patient is seen by an Advanced Practice Registered Nurse (APRN) although, if truth be told, I've known some RNs who were better diagnosticians than the doctors for whom they worked. Still, a "PA" is a long way from an RN and even farther from an APRN. I wonder if Human is billed for a physician's visit.

About 5 days pass and the patient - this scrivener - calls the office to check if (a) the one script was faxed to RightSource and (b) if the three (3) scripts I will fill locally are ready to be picked up. (Never mind that the office should have called me.)

Because my meds previously were mishandled, the scripts no longer are in synch so I get the prescriptions filled when needed. (Insurance carriers make sure I do not get any meds ahead of time; no objection to that.)

When I asked about the three scripts that I specifically requested be written (again, 14 point text) I was told "I think they were ordered through RightSource."

I was told that I could call RightSource and check. I declined and asked that the practice office contact RightSource to find out where are my prescriptions. I didn’t send them to RightSource; I don't know who to contact at RightSource. Bottom Line: Not my job.

I TRIED to share this with Humana.

After all, Leung is a Humana practice and having the prescriptions filled by RightSource costs Humana more than having the prescriptions filled at Publix.

I can contact Humana several ways - via "social media" or through an on-line form. I don't have - nor want - Facebook or Twitter or similar "social media" accounts so that is out. I have managed to contact Humana several times via the on-line form, but not this time.

I tried with Chrome. I tried with Explorer. Neither could open the form. There was zero indication that Humana's system was sick and that I should try again in "n" minutes/hours/days. Click on Compose Message and nothing happens.

The end of the calendar year nears and I'm already looking for a new PCP and possibly a different Medicare Advantage carrier. So far I've found four (4) prospective Advantage providers - Aetna, AvMed, Cigna, and Humana. (The criteria is listing my vascular surgeon; if Jeffrey Hertz is absent from a provider's list, I move on.)

I have experience with AvMed; it was mostly positive and, had it not cancelled my former PCP's contract, I'd still be with AvMed. (To be fair, my former PCP's office staff never seemed to get anything night the first time; sometimes not the second or third time, either.) If I had a problem, I knew who - and how - to contact at AvMed; not so with Humana. I have zero experience with Aetna or Cigna.

I have reason to believe that Humana has a robot that scans blogs and "social media" for certain words - "Humana" being the primary word - so perhaps - perhaps - this rant will get someone's attention at Humana.

I know I can change my PCP at the first of any month, but since I anticipate visiting my current PCP's office only once more before year's end, I can (hopefully) "live with" Leung Healthcare's certified physician's assistant (in lieu of the second physician advertised for the local office).

One thing about Medicare: it's an education. I've learned there are many questions to ask both the Advantage provider and the prospective PCP. Although a patient can change PCPs every month (not advisable), the geezer is "stuck" with the Advantage provider (e.g., Aetna, AvMed, Cigna, Humana) from January to December.

MEANWHILE, if anyone has experience with Aetna or Cigna Medicare Advantage programs, please contact me via email: JohnGlennMBCI at gmail dot com.

Opuscula Humana Promises, just promises

Ahh, Humana. Can you possibly make my life more frustrating?

It states, clearly in my Member Benefit Package, Page 34, that

Mandatory Supplemental Benefit includes: - $115 annual eyeware^cq benefit for eyeglasses or contact lenses and fittings from the network optical provider OR - One pair of eyeglasses at no cost annually, including ultraviolet protection coating.

Moving back in the same document I find one and a half pages of "Vision Providers." Among these providers is the optician I want to use.

The optician works with the ophthalmologist I initially wanted to use. My then-Primary Care Physician (PCP) told me I had a choice: go to the ophthalmologist with whom he had a "capitated" agreement or find a new PCP. I found a new PCP.

I've been told that "capitated agreements" return more money to the referring practitioner and the patient be damned. Capitated, as defined by Merriam-Webster online is found at the end of this entry.

My initial Humana PCP insisted that Humana demanded that I see an optometrist before I could see an ophthalmologist.

I checked on line and found a Humana-approved optometrist (with whom I was pleased). The OD told me to see an ophthalmologist to determine if a cataract was ready for surgery. If it was not, come back to order new lenses.

It is my personal "Standard Operating Procedure" (SOP) not to have a prescription filled by the same practice that wrote the prescription; helps keep everyone honest. However, in this instance - since Humana was willing to pay $115 toward the package, I decided to return to the practice's optician.

It turns out that the practice's intranet was "down" and the optician was unable to access my prescription. She refused to look at a printout I received when the eye exam was completed, and she refused - despite twice being told about a work-around - to do anything sans the intranet.

No one bothered to try to find out WHY the intranet was down; no one called technical support; everyone was content to wait until the intranet finally came alive. I left before it did, if it did at all that day.

Having made an unnecessarily long trip (gas prices in Florida now average $3.64; about a dime above the national average) three times, I thought to use a Humana-listed provider closer to the manse.

I checked Humana's online provider's list. Sure enough, my preferred provider was listed, top of the list based on the search parameters I entered.

I went down to my nearby optician's office and talked to the Woman In Charge, hereafter The WIC.

I gave The WIC my Humana ID card and she tried - for several minutes - to find that I was covered. (Remember, the provider is on Humana's paper and online lists.)

Nothing, nada, effis. I'm the man who never was.

I went home and re-checked the Humana provider lists.

Then I called Humana Customer Service.

Pay attention, HIPAA

After playing 20 questions with Humana's voice response system I finally got a Customer Service Representative (CSR) to talk to me. First I have to answer - again - questions I already answered early in the call. (I shouldn't complain; it was Humana's dime.)

I explained the situation to the CSR and told him I found my preferred provider on Humana's lists.

Yes, they are on the lists, he agreed, only they are not on any list associated with my coverage.

Sudden thought: I wonder if the CSR was looking at a list associated with my initial Humana PCP. I'll try again tomorrow.

NOW, THE HIPAA CONNECTION. While waiting to the CSR to research the issue I could clearly hear other CSRs' conversations with Humana clients, conversation that, per HIPAA, I should not hear. I mentioned this to the CSR and asked if Humana really did record client calls. He assured me it did and I repeated the information about hearing other clients' calls. (I followed up with an email to Humana that might be read by a low-level clerk before end of year when I will have a new Advantage provider.

In the end, I think I'm going to go to one of the several "two pair for $69" opticians; it will cost me closer to $115 (which Humana budgeted but …) but at least I'll be able to read house numbers again.

I would rather that Humana not promise something it has no intent to deliver. I'll chalk this up to "Lessons Learned."

From http://www.merriam-webster.com/dictionary/capitated cap•i•tat•ed adjective \ˈkap-ə-ˌtāt-əd\ (Medical Dictionary) Medical Definition of CAPITATED : of, relating to, participating in, or being a health-care system in which a medical provider is given a set fee per patient (as by an HMO) regardless of treatment required