State attorney general wants feds to investigate Humana claims denials

The Centers for Medicare & Medicaid Services should investigate Humana for repeatedly denying legitimate claims and overcharging members, the Minnesota attorney general announced on Friday.

In a letter to CMS, Attorney General Lori Swanson provided 27 complaints from Humana Medicare Advantage members in Minnesota who allege the insurer overcharged them or inappropriately denied their claims, reported WCCO.

"They were stringing people along, taking months to get back to people," Swanson told the Minneapolis Star Tribune. "Oftentimes, it took the intervention of our office--and oftentimes we had to write multiple times."

Swanson specifically claimed Humana's business practices show a pattern of inappropriately denying claims for Medicare-covered services, overcharging for co-payments and co-insurance, failing to update and adequately disclosing its provider network, and failing to follow appeal procedures.

For example, Bigfork Valley Hospital Clinics and Community in northern Minnesota invested two years to make Humana pay two claims for home care services in 2011 worth a combined $8,700. Hospital employees made more than 25 phone calls, sent letters and supporting documents to Humana regarding the claims, but it still hasn't been reimbursed.

"Humana has been a nightmare to work with due to its frivolous denials, horrible customer service, and lengthy and often fruitless appeal process," Dawn Kern, a business office manager with Bigfork, told the Star Tribune.

Although Humana says it hasn't yet seen Swanson's letter, spokeswoman Kate Marx told WCCO "we take this very seriously and are working to identify the facts."

To learn more:
- here's the Minnesota AG statement
- read the WCCO article
- see the Minneapolis Star Tribune article

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