Humana's response (*2) We'll send you a letter Within the next 30 days

Over the last two weeks I have gotten two (2) recorded messages from Humana's Medicare Advantage organization.

Each time the voice told me that Humana understands my concerns and it will respond my letter "within 30 days."

Is that 30 days from the first phone call or does the second call extend the initial 30 days to 37 or 40 or ?

I have been trying for nearly a month to get the Humana Medicare Advantage organization to answer a really very simple question.

I asked the question via Humana's web site. When I finally got a response it was the usual "We've been busy" (translation: you're stuck with us until December 31 2014 so you're not important to us now) followed words that fail to answer my query.

I ended up writing a paper letter to Humana's corporate office and that, I am certain, generated the "we'll send you a letter within 30 days" phone calls.

This is my first year with Humana; it very likely will be my last.

My previous Medicare Advantage provider was AvMed. As far as communications with its Medicare Advantage operation, I was spoiled. Frequent printed informative materials and email access to the organization's CEO and CMO (Chief Medical Officer).

If contacting AvMed's Customer Server failed to generate a quick, complete response, I could (and did) raise the issue with management. I don't know if either the CEO or CMO actually received my electronic missives, but someone acted on them on my behalf . . . and I never had to wait 30 days for a snail mail reply.

My question to Humana was simple:

Which of the following four Humana Advantage-listed Primary Care Physicians (PCPs) are allowed to refer to the following two Humana Advantage-listed specialists?

I

It seems the PCP I selected was not allowed (he told me) to refer me to my long-time ophthalmologist. Since an optometrist - who I was forced to see before I could get a referral to ANY ophthalmologist - said the developing cataract in my right eye might be ready for surgery - adding that surgery was the ophthalmologist's decision, not his.

Since I am new to Humana's way of doing things I was surprised that any Humana-listed PCP was prohibited from referring ("getting authorization for") to any Humana-listed specialist.

I selected Humana Medicare Advantage largely because it listed my specialists - the ophthalmologist and my vascular surgeon. (The latter performed an open AAA repair; tricky, time-consuming, but effective.) Humana also offered me a roughly $200 annual savings over my previous plan with AvMed.

My first Humana-listed PCP told me that he was not allowed (by Humana) to refer me to my ophthalmologist; the vascular surgeon was referable. Given that, he said, I had two choices:

1. Go to an ophthalmologist to whom he could/would refer

2. Find a new Humana-listed PCP who could/would refer to my ophthalmologist and surgeon.

I opted for Number 2.

The catch was that, PCP #1 said, I would have to either
(a) contact each PCP individually and ask "Do you refer to Specialist 1 and Specialist 2?" or
(b) contact each specialist and ask "Do you receive referrals from one or more of the following Humana-listed PCPs?"

I'm paying Humana more than $100-a-month AND Medicare is paying a substantially greater amount to Humana for "geezer care." That being the case - and, again, never encountering this problem with AvMed - my position was: Not my job.

I'm confident that Humana can, within a maximum of 5 minutes, plug PCP and specialist information into a computer and have it sort who refers to whom.

Meanwhile, the cataract is becoming as "ripe" as a two-week old tomato.

In the end I did some research on my PCP options. Three of the four have lousy on-line references; I discounted these since most people prefer to complain rather than praise (I am not "most people" and I have high praise for my practitioners.)

I made up a questionnaire for the PCP candidates:

Do you refer to the following specialists?

My thought was that how the questionnaire was handled would tell me a lot about the office and, indirectly, the practitioner.

Two of the PCP candidates were located near my favorite medical lab. (My meds force me to visit the lab four times-a-year.)

When I showed up around 10 a.m. there was no available parking. There were a few "Reserved for Physician" slots, but a four-story parking garage and surrounding surface parking was filled to capacity. (I get to the med lab at 7:30 so there is never a parking problem.)

On to the third candidate.

I had the address and I know my city. But I never found the practitioner's office.

On to the last - and most distant from my residence - candidate. This practitioner had no "knocks" on the WWW.

Lots of off-street parking.

I go to the receptionist and explain that I have a questionnaire about referrals.

Immediately I am told to go inside and talk directly with Melissa, the Sweet Young Thing (SYT) that handles referrals.

I present my list and to my surprise I'm told "We refer to all of these doctors." (The list included three orthopedic surgeons.)

When I explained my query about the orthopedic surgeons she volunteered that one of the surgeons specialized in hands and shoulders and one was hips and legs; she didn't know the third's area of interest.

On the way out I asked a waiting patient what she thought of the practice: her response was positive.

I contacted Humana by phone and set Leung Healthcare as my new PCP. I was told I would get a new card in about 14 days. The card arrived the other day; so far the ONLY thing Humana has done in a timely manner.

And, an added benefit with this new PCP's practice: it also works with AvMed.

Meanwhile, I'm still waiting for Humana's promised paper letter.

Humana Medicare Advantage plan But it LOOKED Good on the web

Last October I changed Medicare Advantage providers.

My previous provider cancelled my Primary Care Provider's (PCP) practice.

I was loyal to the practitioner; I credit him with saving my life. On the other hand, the practice's office staff leaves more than a little to be desired; the word "incompetent" comes to mind; if I were not a gentleman I would suggest the old military acronym "SNAFU," but I'm polite so I'll forego the term.

Anyway, for reasons known only to the practice and AvMed, my previous Medicare Advantage provider, the insurer dropped the practice. I was left with several options:

1. Find a new plan that listed my PCP
2. Keep AvMed and find a new PCP from its list
3. Find a new plan and a new PCP

Ever since I signed up with AvMed I checked other plans during the annual sign-up period. I never found any to compare with AvMed, and my experience with the company has been better than pretty good. There were some hiccups, but since I had the email addresses of company executives and since the executives were responsive, all issues were resolved fairly quickly. (The email addresses and snail mail addresses were included in every AvMed customer newsletter.)

But, given that I was unhappy with AvMed's chutzpah to cancel MY PCP I checked out many other Advantage programs in my area. Since there are many geezers in my area there likewise are many plans.

I talked to a Sweet Young Thing at Blue Cro$$/Blue $hield. I rated BC/BS as "greedy." (Providers get substantially more from our favorite uncle (Sam) than a geezer's $104 and change-a-month.)

Humana caught my attention by its incessant advertising on the radio-with-a-picture.

What the heck; I'll check out the Humana site.

According to its on-line providers list, it had my ophthalmologist and vascular surgeon, two practitioners I see at least annually. Surprise, the co-pays to see a specialist were $20 less than AvMed.

I next went through the PCP options and found one I thought would be copacetic. We even interviewed each other before I signed on with Humana. Nice guy. Been around awhile. When I put my John Henry on Humana's dotted line and became a Humana client I named this practitioner as my PCP.

So far so good.

Most Medicare Advantage programs - now including AvMed - require a PCP to

     (a)    Determine if a referral is medically necessary

     (b)    Apply for an authorization to refer the patient to a specialist or for more than routine lab procedures

     (c)    Refer the patient to the specialist (or medical lab).

Meeting with my new PCP since I became a Humana client I asked for two referrals, one to my vascular surgeon and one to my ophthalmologist. The surgeon performed an open abdominal aortic aneurysm (AAA) repair and my visit was my anniversary follow-up. That referral was approved.

The ophthalmologist was a different matter.

First I had to have a refraction by an OD (optometrist) and then if the PCP was satisfied that I needed to see an ophthalmologist he would appeal to Humana for authorization to allow me to see an ophthalmologist.

The OD told the PCP that he considered my cataracts ripe for surgery.

Then the PCP told me he could not refer me to my ophthalmologist.

Why not? The man is listed as a Humana provider - TWICE.

"Well," the PCP said, "Humana tells me to whom I can refer and your ophthalmologist is not on my list."

LUDICROUS !

My Humana PCP is prohibited from referring me to a Humana-listed specialist.

The PCP called me at home and explained his situation and offered me two options:

1. Accept a new ophthalmologist, one to whom the PCP could refer
2. Find a PCP that could refer to my ophthalmologist.

In the latter case the PCP told me to check with potential PCPs on Humana's list and to check with the specialists to see who is allowed to refer to whom.

Bothering prospective PCPs or my specialists is NOT the client's job.

Humana has a "Contact Humana" web mail on its site. I used the web mail to ask Humana which of my prospective PCPS could refer to my specialists.

This was the second time I had to contact Humana.. The first time it took three tries before I got a response and an excuse: "We've been busy." Sounds like poor management to this customer.

So - after two weeks, I still am waiting for a reply from Humana . Not a difficult question and one that Humana should be able to answer with little effort.

PCPs A, C, E can refer to Specialists 1 and 2.

I finally gave up and sent a real, paper, letter to Humana. We're about to go into Week 2 of no response (Week 3 for the web mail query).

Somehow I came across the name of a person who claims on LinkedIn that she is the Director of Customer Relations for Humana. UNFORTUNATELY there was no address to contact the woman. Humana carefully hides the people in charge - unlike AvMed.

It's a pity that potential clients can't pretend to be clients to see how responsive the vendor is to customer inquiries. Had I suspected Humana to be so customer UNfriendly I would have stayed with AvMed and paid a slightly higher co-pay for specialist visits and Tier 3 prescriptions. (I don't visit specialists all that often and the difference for a year's worth of my costly meds is $100; overall, a small price to pay to have a Medicare Advantage provider that doesn't hide from its clients.)

If, at this point, anyone would ask me if I would recommend Humana, my answer would be an empathetic NO.

I watched as AvMed dropped and then restored my ophthalmologist so I have some minor hope that it will relist my original PCP. (If only his practice could straighten out the administration side.)