Category Archives: Humana Gold Plus

Hey, Hey, Ho, Ho…HMO’s Have Got to Go: InHumana, cont’d.

Dear Readers: I beg your indulgence one more time, so that I can finish the narrative of my previous post, “InHumana”.

After spending untold hours yelling and screaming, complaining and pressuring the folks at InHumana, my mother was transferred to another facility late yesterday afternoon.

My day began by contacting InHumana’s Customer Service department, and after speaking to one woman, I asked her to transfer me to a supervisor. I told both the CSR and her supervisor that the facility my mother was in was a dump and a roach motel.

I criticized the company for limiting the choices of facilities in my county, and as I said in my previous post, that was like wanting to buy a car, and your auto insurance company limits your choices to x number of dealers, and an even smaller number of models to choose from, which corresponds to number of “InHumana beds” available in each contracted facility.

While the supervisor escalated the issue to the Access to Care team, I contacted InHumana’s CEO and President, Bruce D. Broussard’s assistant. She transferred me to their Expedited Resolution team, and spoke to two women.

I had previously sent my article, “InHumana” to Mr. Broussard on Sunday evening after I wrote it, and informed all four women I spoke to. I also tweeted Mr. Broussard throughout the day.

I gave InHumana an alternate choice, and was informed some time later that they did not have any “InHumana beds” available at that facility. I told the women that I did not care if they were contracted or not contracted with a better facility, I wanted my mother taken out of there by end of business day.

I told them that as a $41 billion dollar company, that is about to be sold to Aetna, they can afford to spend a little more to put my mother in a better facility. They informed me that because she was in their Medicaid HMO, she was limited to certain facilities.

In the meantime, I called that dump, and spoke to the Case Manager there and informed her that I was upset with the quality of the facility, and that I wanted to have my mother removed from there. She also said I was limited because of her insurance, and said the same thing to her that I said to InHumana.

I threatened to call our attorney if InHumana or the roach motel did not get her out of there, and spoke to his assistant, who had returned my previous call from the previous Friday.

Later in the afternoon, I received a phone call from a woman from InHumana who said she was the representative for this area of Florida. She was contacted to assist, and was having my mother’s case reviewed by their medical director.

After doing some more yelling and screaming at the Expedited Resolution team member to get my mother out of that roach motel, I received a call from the Admissions person at the first facility we contacted on Sunday. She told me that they had a patient go home and that there was a bed available, and that they were going to make arrangements to have my mother transferred.

So it wasn’t due to InHumana’s efforts that my mother got out of that roach motel, but rather serendipity that a patient went home, thus opening up a bed.

But it did not have to be that way. This could have ended early on in the process if InHumana was more interested in the medical care of the patient, instead of protecting their bottom-line, and their shareholder’s value, not to mention the compensation Mr. Broussard must be getting, which would probably cover my mother’s stay in this new facility for quite a long time.

Today I informed by the Admissions office that InHumana only pays for TWENTY DAYS of rehab, and since she spent one day in that roach motel, we already used one day, so we have nineteen more days for them to pay.

After that, it becomes our responsibility, at $150 a day. I don’t know how long she is going to be there, but we don’t have that kind of money, so I will contact our lawyer for his advice,

This is why, along with the aggravation they put me through yesterday, I called this article, “Hey, Hey, Ho, Ho…HMO’s Have Got to Go”.

THEY ARE CHEAP BASTARDS.

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InHumana

The following post is personal. In fact, it is very personal, so if you think that personal issues should not be aired on this blog, I beg your indulgence, and hope that after reading this that you will overlook this indiscretion. Also, it is somewhat off-topic, but when has that ever stopped me?

Early Friday morning, my mother fell in her bedroom. When her home health aide and I found her after unlocking her door, she was on the floor near the foot of her bed.

I called 911, and when they arrived, they attempted to pick her up, but she complained of pain, so they transported her to the nearest hospital for x-rays.

She was admitted to Bethesda Hospital West, a relatively new hospital in my area. In 2013, my father was taken to this hospital when he fell in the house, so we were familiar with the hospital and liked it.

Sunday morning, I was informed that she was going to be discharged and that the hospital was trying to get her into a skilled nursing and rehab center near the parent hospital of Bethesda West, Bethesda East.

The day before, the Case Manager for the hospital gave me a list of twelve centers that my mother’s insurance company, Humana, has contracted with.

Out of the twelve rehab centers, only three of them were less than ten miles from my house. The Case Manager contacted the Admission person for the center near Bethesda East, but when I tried to reach this woman, I had to leave voice messages for the woman who handles admissions during the week.

Every other center the Case Manager called did not have any Humana beds, and when I tried to call Humana’s Customer Service number from my house, their automated system informed me that they were closed. Yet, the Monthly statement they sent us says that you can call Customer Service on Saturday and Sunday.

The other rehab centers on the list are either too far away from my house, or too far for my mother’s aide to go to, so would have required us to get a new aide who would be unfamiliar with my mother, and who my mother would be unfamiliar with.

The orthopedic surgeon who consulted on my mother’s case recommended a place to my brother, who is also a physician, but he did not write down the name of the center.

When it was time to transport my mother to the rehab center that did accept her, I went ahead, and when I got there, I saw that the place was a dump.

The décor was ugly and outdated, the staff was just as ugly and looked very unprofessional. The place smelled, and the room was too small. The family of her roommate were too loud and looked like refugees. The staff had to ask them to go to another room because they were too upsetting to me and my mother.

If one was to compare the atmosphere and ambiance of Bethesda West to a five-star hotel, being transported to this rehab center was comparable to being in a roach motel.

I expressed my displeasure to the head nurse at this facility, and she understood my feelings. I told her that I was not taking this out on her, but rather Humana for the way my mother and I had been treated in getting her transferred to a rehab center.

This episode demonstrates that Humana’s only concern is with saving money, protecting their bottom-line profits, and being more concerned with their shareholder’s value, rather than the value such treatment would have on the patient and the patient’s family members.

Humana’s lack of sufficient, nearby alternative rehab centers, when there are plenty of other places in the area, their failure to accept where the hospital or the orthopedist recommended my mother to receive physical therapy, is example of how bad our health care system treats elderly patients and their families.

Therefore, I have called this article, “InHumana”, because they are inhumane, and quite frankly, suck. And now they are going to be bought by Aetna. So now, they are going to get bigger, more profitable, and probably cutback on services and facilities, instead of allowing patients to go wherever they want to go, or wherever a doctor recommends them to go.

It’s like this: say you want to buy a car, but your auto insurance limits you to only twelve dealers, and most of them are too far for you to travel to, and when you contact these dealers, they don’t have the kind of car you want. This is what InHumana is doing to us. They have limited the rehab centers we can choose from, and the ones we wanted don’t have any “Humana” beds available on a Sunday afternoon.

This is not only insane, it is also insulting to the families that they do not have a say in where they want their loved one to receive care. I guess the g-damn bottom-line is more important to InHumana than patient’s well-being and that of their caregiver family members. In a word, InHumana is cheap.