Medical Billing Forum

Billing => Billing => Topic started by: kbolt on July 17, 2008, 03:24:54 PM

Title: Humana problem
Post by: kbolt on July 17, 2008, 03:24:54 PM
Humana has not processed ANY of our claims for dates of services in June correctly. If our charge is $95 they discount $95 stating it is a contractual obligation. This is not true, we do contract with Humana and they have always paid correctly, even for May service dates. We have over $14,000 worth of claims and cannot seem to get help from the representative assigned to our case. It has been close to a month now and have no answers or clues. If anybody else is experiencing this problem or if you know of any contact person in Louisiana that may help, please let me know.

Title: Re: Humana problem
Post by: Cady on July 17, 2008, 08:30:40 PM
Is your office have a contract with Humana? They should honor the contract's terms including the fees schedule!! Make sure you reread the contract and that they did not apply any deductible. You need to talk to them underlinging the therms of the contract you have with them. If it's not resorving the problem you need to seek legal help.( lawyer experienced in health law or contracting)..

Good luck.
Title: Re: Humana problem
Post by: Michele on July 17, 2008, 09:44:44 PM
Since the representative assigned to you is no help, I would recommend going to his/her superior.  You can either say something to him/her like "Listen, you don't seem to be able to get this straightened out and my Dr is getting extremely upset so I think I need to talk to your manager."  If you're not comfortable with asking them directly for their manager then you can call in on the main number and ask for the name and number of his/her manager and just call directly. 

In either case, usually when you push to go up a step you will find action gets taken.  Either the original representative will suddenly get things cleared up, or their manager steps in and fixed it. 

You can get very firm without getting rude.  They are messing with the Dr's income so I never fail to mention how upset the dr is getting.  You may want to consider mentioning that the dr is considering dropping out of the network.  He can't afford to not be paid.

Sometimes we are too patient and when we put our foot down (Enough is enough!) things get cleared up much quicker.

Good luck!  :)