ComplaintsforHumana Military Health Service

• Initial Complaint

  01/24/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  10/12/2023 got a tdap vaccine in my primary care’s office. They submitted claim to Humana and it was denied saying I had to pay it first (paid bill 11/20), submit a claim form (recd 11/20), and copy of the invoice directly for reimbursement. This was done 12/3 and I received a letter 12/11 saying the vaccine was covered. On 12/15 I called and they said it was processed and DMR approved. Check mailed 12/19. On 1/10 I called to say I have not received the check. I was told I had to wait 30 days to get it reissued (so 1/19). Called again 1/24 to get reissue and a case was opened. Now they say reissue will take ANOTHER 30 days. This is unacceptable for a claim from October, so 90 days!! I request this claim be paid immediately! At this rate they should pay me interest.

  

  Business response

  02/14/2024

  See attached response from the business.

  Customer response

  02/14/2024

  
  Complaint: ********
  
  I am rejecting this response because: 

  I have sent the required copies to you at the new address, but have not heard if a check has been sent. When I know you mailed the check, I’ll close his case

  Sincerely,
  ******* *******

  ************

• Initial Complaint

  08/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have 2 complaints. (The second complaint is the one that made me file a complaint) The first one is that I was told by 4 Active Reserves who went through the same thing I'm going through and they said that I was eligible for TAMP coverage, which provides 180 days of premium-free transitional health care benefits. When I called Tricare, they said that I'm not eligible even though I was on "active orders" in Illinois for Bootcamp, and in Texas for A school. The second one is that I call insurance ************** on May 5 to see if they cover an eye exam and they authorized the referral on that day and an appointment on May 8 for an eye exam. (The claim number: *************** Case *****. Request number: 8L3). Insurance paid the $80 dollar to the eye doctor, ******* ******, and everything went well. Months later on August 11, I received a call from the eye doctor *************) saying that my insurance called saying that I was not eligible for the eye exam on May 8 and that they want the money back, and that I should pay the $80. I called the insurance ************** on Aug 14 and talked with ****** and the supervisor named ****** They said that I stop being eligible on May 2 but somehow they by error approved and paid for my May 8 appointment and now they want it back. I would have not done an eye exam if it was not covered by my insurance. Because of their mistakes now I have to pay $80, which I think is unfair.

  

  Business response

  08/23/2023

  Please see attached response.

• Initial Complaint

  07/12/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had to go to the emergency room in Weisbaden Germany on 24 Jan 2023. They don't take insurance. I had to pay 514.34 Euro in order to be seen. When I cam back from my trip I filed a claim. I filled out the DD2642 and faxed it, along with detailed reciept to the insurance company in March. I called Humana on March 29th and they said they had recieved it but that they needed more time to process. I realized this week that I still hadn't gotten a payement so I called on 10 July 2023. The first representitive couldn't find my claim and when put on hold to speak with a supervisor was disconected after over 30 min on the line. I called back. This time, the representitive said they found the claim number but that it was denied and that I had to speak with a supervisor. After speaking to the supervisor they informed me that I may have to re submit because they couldn't find it in the system. I told them that because of their archaic methods of document submission (US Mail or Fax) that the same thing would happen. The reason being there is no claim number assigned until they get the documents and create one themselves--so one must rely on the people getting the faxes and mail to assign the number and then be able to find said number when called. I asked to speak to the next supervisor. The next supervisor's name is ***** ** She found the claim but then informed me that their system was down. She asked for my phone number and told me she would call and finnish the claim when it was back up. She said there is no direct email or phone number to reach her. I haven't heard anything for two days. This is ridiculous that a company this big can continue to use a system that relys on Mail and Fax with no assigned Claim number, no direct phone number, or no email. The VA has a better system than this. I can only imagine how many claims have been ignored throughout the years.

  

  Business response

  07/31/2023

  See attachment for response.

  Thank you, 

• Initial Complaint

  04/20/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have contacted Tricare twice over the last two weeks after I was authorized for a doctor transfer. To date Tricare's referral team has not reviewed the request from the recommending doctor. This delay has left me unable to seek medical care.

  

  Business response

  05/15/2023

  Please see the attachment for the company response. 

• Initial Complaint

  03/23/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I am the sponsor. My husband ****** ******* ****** ********* had a ** ************** done on 2/2/23. At that time, the deductible was paid upfront to promedica ****** ******** of $182.00 I received a bill from ****** R*********** ********** from 2/2/23 (claim ******** ******** stating I owe $83.22 for the deductible. On 3/21/23, I called Humana East and was told they could not help me and they advised that I needed to call ********* ****** ******** to have them refund me the $83.22 so that I could pay the ****** Radiological Associates bill. I spoke with Adrianna B Reference # 18543687 with Humana. On 3/22/23, I called ********* ****** ******** to ask for a refund per Humana's representative's advice (I asked for a refund of the difference of what I paid vs the patient responsibility upfront) and they told me they could not do this. I then called ****** ************ ********** hoping they could re-submit the claim so it would show the deductible was met and tricare would cover more of this test. However, they told me to call Humana.

  

  Business response

  04/10/2023

  See attachment for company response.

  Thank you, 

   

  Customer response

  04/11/2023

  
  Complaint: ********
  
  I am rejecting this response because: the beneficiary has not received any response (via postal mail, email or phone) as of 4/11/23 in regards to this matter. 
  
  Sincerely,
  
  ***** ****** *** ****** ** ****** *******

• Initial Complaint

  03/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  June 2, 2022: I mailed claim for $3,350 for dependent ***** ******** mental health care with ***** *** *** July 6, 2022: I spoke with TRICARE East representative ***** who could not find claim in their system; I then spoke with supervisor ******* who found claim split into two ($1,850 for 8/31/22 - 12/15/21 and $1,900 for 1/12/22 - 5/25/22) and said it would be processed soon as self-submitted claims are to be processed within 30 days. October 17, 2022: I spoke with TRICARE East representative Catherine who said they erroneously processed only one line item of $3,350 claim (only $207 check mailed to me) and that she was escalating claim to be resolved within 10-15 business days. EOB dated 7/18/22 listed claim number 20221570000412 for which $207.23 of $1,850 was reimbursed & claim number 2022157 0002071 for which $136.30 of $1,900 was reimbursed. October 26, 2022: I received EOB stating TRICARE allowed $412.35 but only mailed me check for $56.15 November 2, 2022: I mailed certified letter to Humana Military/TRICARE East appeals as per EOB right to appeal. November 18, 2022: I received letter from Human Military/TRICARE in reference to only one of the two claims (claim number ******* ********. It also did not explain rationale for their minimal, partial reimbursements. We demand full reimbursement for both claims as we provided all forms, provider statements, and a referral. Please see attached appeal letter we mailed USPS certified on November 2, 2022 regarding both claims.

  

  Business response

  05/11/2023

  The company provided a response directly to the customer.

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