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:
- Find a new plan that listed my PCP
- Keep AvMed and find a new PCP from its list
- 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:
- Accept a new ophthalmologist, one to whom the PCP could refer
- 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.)
