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.
