Hell (Photo credit: KomodorO // Paco LopeH)
Surviving Humana Gold Plus HMO hell is a matter of praying you don’t get sick, injured or diagnosed with a serious disease and you survive by counting the days until open enrollment.
My advice to anyone who is even considering any HMO – run to a PPO as quickly as you can.
This has been a nightmare.
When my husband and I started to look at Medicare supplements we invited a Humana sales person to our house. His name is Matt. Matt sat at my kitchen counter in my house and this is how the conversation went when I asked for clarification to my health care providers:
Carole: “Matt, if I understand you then I have to choose a Primary Care doctor here where we live but I can still see specialists as long as they are Humana providers.”
Matt: “Yes, that’s right.”
Carole: “Please check and see if these doctors are in network, and the oncology center I use for check ups.”
Matt (after checking) “Yes they all are.”
BAM done deal.
The problem with this scenario is it was ALL lies. The Primary Care doctors I chose where I live do not refer out to my oncology center. I am in the middle of post breast biopsy care for the next two years. I have to have an ultrasound every February and my routine mammogram in July. I have had one major surgery on my breast and 2 biopsies and my breast is filled with strange gobblelty gook that even the trained eyes of the top radiologists in my oncology center get second opinions on before discharging me from my appointment. A new mammogram center will see all this and go nutty. My oncology center doesn’t accept films from outside clinics so if they see nuts and bolts that would mean another mammogram AND twice the radiation.
Fact of the matter is that my breast surgeon and I had already discussed a mastectomy because my scans are so difficult to read. That won’t happen while under the care of the Humana nazis.
What will I do? I will call my oncology center and I will negotiate a price and pay for it out of pocket. I will not have my mammogram done at a center I never used before so my bad, I will pay the bill myself. Thankfully I can afford to do this.
Oh but it gets better.
The original PC doctor I chose did not make my RN socks roll up and down and I started the procedure of changing to a female physician for all things female. The hoo-hah is tired of being in the hands and face of anymore male doctors.
Humana Gold Plus HMO in their infinite wisdom put my first choice to change Primary Care docs through but neglected to tell me that the request had been kicked and I did not get the new female PC. However to be fair – the customer care rep got this fixed in about 20 minutes. Normally I spent almost an hour trying to get assistance and the people on the other end of the phone are not decision makers.
But…….I am also in the middle of a trip and fall at home and I had already seen my first PC for this and had been referred to his preferred Ortho doc (note I wrote “his preferred”.) As an RN I am used to vetting my doctors with other nurses. I went to see this Ortho doc and in less than 5 mins he told me I probably have a torn meniscus and only an MRI would give us the diagnosis. I asked if this is a surgical repair only, and he said it was. Well that’s not totally true. Depending on the tear PT can work. I have not had that MRI because the first PC doc never gave us the referral approval to have it, and I filed a complaint on that. Another screw up – almost a comedy of errors the change went through for the new PC doc so that was all behind me because she doesn’t use that Ortho doc.
Now I have just had my new choice of a Primary Care doc approved and I call for my first appointment. My knee is hurting and I am also sick with an upper respiratory infection. Ready???? May 2 is the appointment I am given. I explain my injury, I explain I am sick – did not make one effing difference – May 2.
Let’s look at the timeline here. 2/19 injury. Knee started to hurt 3 wks later. I get to see new PC 5/2 which is 2 1/2 mos after injury.
By the time I see her chosen gods of orthopedics it will be 3 mos. MRI will be about 3 1/2 mos of pain and potentially doing damage to my knee because no one has told me what to do, what not to do, and this is what you call good medical care? Its NO medical care.
I cannot change to a doctor who would see me sooner because that approval won’t come through till 5/1 so I HAVE to see this new PC doc and only her. What does her staff tell me? Go to a walk in clinic. What will that do? Seriously they told me in the meantime if I get sick I should go to a walk in clinic. I got back on the “Humana Not So Hot” line and was given a walk in clinic they have on their list – ready? Doctors are only there Tuesdays and Thursdays. I better not need a doctor any other day of the week.
I feel like I am a hostage to Humana Gold Plus HMO and that I am close to being denied medical care. Until May 2 my hands are tied and this is worse then when I lived in Central America. It is an embarrassment and I am disgusted beginning with Matt, moving on to Humana Gold Plus HMO, going on to the new PC and her staff, and with myself too for being fooled so a sales person could put a commission in his bank account.
Today is April 5, there are 270 days left this year and I am counting. I will go back to a PPO and just move forward. Yes, surviving Humana Gold Plus HMO Hell is something I can work around but my advice to anyone else is doctor shop and ask each office whom they refer you to if you need a specialist if you join any HMO plan. Make sure you can get referred to that gynecologist you like, that you can keep that cardiologist who did your angiogram that saved your life, and that your oncologist whom you trust with all your heart is someone you can keep. HMO’s are all about money they don’t have to spend not managing our health, not being a health care advocate.
There are many other complaints about Humana Gold Plus HMO on line. I should have googled them before going with them.