Humana is a scam and takes advantage of Senior Citizens
My mother is 76 years old, low income, has dementia and high blood pressure. I switched her from AARP to Humana Walmart Plan for her blood pressure medicine on April 1, 2011. The salesperson assured me that her blood pressure medication, Tiazac 240 miligrams, was on their list of "Formulary" drugs and all we would have to do is pick up her medication once a month at a Walmart pharmacy for a nominal fee. Being that Tiazac is an old medication I explained to the salesperson that the whole reason we were switching her is because AARP had removed the drug from their "Formulary" list and placed it on "Non-formulary" and that I've had all sorts of problems with them because of it. I also explained to him that I had a written note from my mom's physician stating that they have attempted to use generic forms of the medication for her in the past and it was unsuccessful. She can only use Tiazac. The young man gave me a fax number and asked me to fax him the note and he would put it on file so that if in the future Humana took her medication off their "Formulary" list we wouldn't have to go through the same problem again. I was relieved. It all worked great until this month, February. I went to pick up my mom's medicine and Walmart told me it would be $96.50 instead of the normal fee we had been paying of $6.50. Apparently, Humana removed my mom's medication from their "Formulary" list and placed it on the "Non-Formulary" one. I was told that in order to get her insurance to cover the medicine, regardless that her prescription from her doctor is still current, I would need to have her doctor's office fax over "prior authorization" and that the process would take 72 hours. I called her doctor's office and left a voicemail for them to do this and I also waited 72 hours. Today, I called the Walmart pharmacy to see if the matter had been straightened out and was told no. I called Humana at 9 am this morning and that's where the fun began. The representative told me she was unable to speak to me without my mom's permission. I explained to her that my mom has dementia and I'd be happy to conference her into the conversation with Humana by calling her with my 3way calling feature on my phone, however I told the representative to be prepared because my mom talks and talks about things that have nothing to do with the subject at hand and she doesn't understand things very well. The rep said ok so I conferenced my mom in on the call. After 15 minutes of my mom talking about random things (thanks dementia) she finally gave verbal permission to the Humana rep to speak with me. I asked the rep at that time if she would please note in the records that my mom had given verbal permission for them to speak with me in case I had to call them back so that we wouldn't have to go through this process again. The rep advised she was not able to do that, all she could do was send out a written form for my mom to fill out and send back and it takes a couple of weeks. Though frustrated with this information, I continued on with my reason for the call. I asked the rep what the status of the prior authorization was. She informed me that they hadn't received anything from the doctor's office. I advised her that my mother's doctor's office faxed the info the day before. The rep said that it might be in the fax cue but there's no way to tell and it will take another 72 business hours. She said that they could "expedite" it if the doctor's office would give them verbal permission. I said great, can you please conference the doctor's office in on the call so we can get this taken care of? The rep said she is not able to make conference calls and that I could feel free to hang up with her and call the doctor's office and then call Humana back. I pointed out that if I hang up with her and call back she will again need my mom's verbal permission to speak with her and that will take another 10 minutes or more of listening to my mom tell her everything under the sun. She still insisted it was the only way. Rather than hang up with her and have my mom do this all over again, I asked for a supervisor. After several minutes of the rep asking me why I wanted a supervisor she finally complied with my request and got "Denise" on the line. Denise was able to attempt to call the doctor's office but she reached the nurse's voicemail so she was unable to speak to anyone. She left a message with the doctor's office and said that if they would call her back with the prior authorization she would expedite it through and I could get my mom's medicine immediately after. I hung up and shortly after the doctor's office called me and said they had called Humana and gave the prior authorization. Great, finally after 3 hours of being on the phone I could finally get this resolved! I was so happy. I called Humana back and after 30 minutes of explaining to the rep that I needed to speak to Denise and also after conferencing my poor mother back on the phone and having her tell them random stories for 15 minutes before finally telling them they had permission to speak with me, Denise finally got on the phone. She said she received prior authorization and placed me on hold for 20 minutes while she had the "Review Board" look it over to approve it. She finally came back on the phone and said it had been denied. I asked why and she said that even though they received the prior authorization that they still cannot approve it because the doctor didn't specify that my mom can't take generics. I explained to her that they already had this info on file and for that matter so does the Walmart pharmacy we use. She said that didn't matter, they need it again. I asked her if she could conference in the doctor's office again and get what she needed from them this time. She said she couldn't do that, that my mother would have to file an appeal since it's already been denied. I explained to her that we had gotten everything that Humana was requesting and that there was no mention of this prior to them denying the prior authorization. Again, she stated she cannot do anything and it will have to be appealed and it will take 4-6 weeks. My mom has 3 blood pressure pills left. They will run out on Sunday. My only other option is to take her heating bill money and go buy her medicine at full price. The whole ordeal today took up 5 hours of constantly being on the phone. I feel that Humana placed unnecessary requests upon my elderly mother being that they already have this information on file in the first place. I also feel that even after we complied with EVERYTHING they asked us to do they still denied and came up with another unnecessary request that hadn't been mentioned before and is again, something they already have on file. I am at my wits end so I can't even imagine what this all must feel like to other Senior Citizens that have to deal with Humana.