Image result for humanaI am sure you’ve seen numerous and appealing commercials lately from Humana Insurance Company pushing their Medicare products.  I cannot attest to how Humana handles Medicare Supplement and Medicare Advantage claims, but I can tell you that my experience as an insurance agent with Humana was horrendous, and I’ll never sell for Humana again.

I originally applied to and was appointed by a company called Kanawha Insurance Company to sell their excellent accident disability insurance via payroll deduction to employees of private and public entities.  That product was the best I ever had to offer in my 44 years in this industry, and Kanawha paid their claims promptly and fairly.

Humana acquired Kanawha Insurance as a subsidy, apparently wanting to enter the Worksite Marketing arena, which has been growing exponentially, especially in the revived Trump economy.

But within a year, my clients started complaining Humana was delaying claim payments and denying claims to the point I was dreading even answering my telephone!

My first indication that something at Humana was very wrong was over a client who went to the gym to work out and used too much weight.  She had a shoulder injury requiring surgery to correct, and was put on light duty, so she wasn’t eligible for the disability benefit, but the policy provided up to $2,000.00 for medical expenses.

I always have my clients send their claim forms to me first, so I can make sure the claim is complete before submitting them to the various insurers I broker for.

This client’s claim was fully documented as an accident by the physician and included the client’s medical bills, so I forwarded her claim to Humana and fully expected she’d be paid promptly.

About two weeks later my client called to say her claim had been denied, and the only explanation was that the policy only covered accidents!  I instructed my client to get a letter from her doctor that stated she had an accidental injury and sent it to Humana via certified mail.  In response, my client received another letter from Humana’s head of operations, again insisting they did not consider her claim to be an accidental injury.  The letter told her that she had an injury, but not an accident, so they didn’t have to pay her!

That’s when I knew it was intentional.

I instructed my client to file a Small Claims action against Humana, and told her I would appear alongside her in court as an expert witness, which would require me to drive down to Santa Cruz County in California from my second home in Eagle Point, Oregon.  I didn’t have to that time, because Humana called her and settled the claim for $3,000.00 a week before the scheduled hearing, which was $1,000.00 more than had they paid the claim promptly.

Following that, more and more clients began calling me to complain their claims were being delayed and denied right and left!  My own wife, who was also a Humana agent, had been injured in an auto accident.  Humana paid her for about 10 months of the 12 month disability benefit, and then just arbitrarily stopped the payments and refused to pay the balance.  She had to file a Small Claims action here in Oregon and the judge ordered Humana to pay her the balance due her.

They were even trying to rip-off their own agent!

I had to drive down to California four times to appear in Small Claims Court for my clients, and the court ordered Humana to pay every claim after I testified on their behalf.  In other cases, Humana settled with my clients just before the hearing date.

It got worse when Humana began requiring my clients to have a 12-page accident claim form completed, instead of accepting the single, front & back page claim form Kanawha required.  In my opinion, this tactic was intended to discourage my clients from pursuing their claims, and their physicians were miffed by all the unnecessary additional information the 12 page monstrosity required.

I could go on, but I think you get the picture.  Since then, Humana has sold their Kanawha holding to Manhattan Life, and their claims handling seems to be getting much better now.  At least Manhattan Life isn’t looking for any possible and ridiculous excuse not to pay, like Humana did.

I don’t know if Humana handles their Medicare product claims the same as they did the Kanawha claims, but I would be remiss if I didn’t tell you, “Buyer Beware”!

Carl F. Worden

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