Humana Used Obamacare as Club Against Policyholders, Class Claims

KANSAS CITY, Mo. (CN) – A federal class action claims Humana jacked up its health insurance premiums to coincide with Obamacare, while failing to give policy holders a reasonable way to cancel policies.

Lead plaintiff Daniel L. Doyle sued Kentucky-based Humana on Tuesday.

Doyle says he received a letter from Humana in August stating that his policy would be canceled on Dec. 31, 2013 and replaced with a new one, to coincide with the Affordable Health Care Act.

The premium for the new policy would be $395.97 a month, significantly (73%) higher than the $229.30 a month Doyle had been paying.

Doyle says he received another letter on Oct. 24, 2013 with clarification to the August letter. He then found a better policy with another provider and wanted to cancel his policy with Humana.

“On or about November 20, 2013, Mr. Doyle was notified that he had new insurance coverage with Blue Cross Blue Shield beginning December 1, 2013,” the complaint states.

“Plaintiff then immediately attempted to contact Humana to cancel his policy but was unable to reach anyone who could assist him to cancel.

“Plaintiff again tried to cancel two to three days later. He again was unable to reach anyone at Humana who could assist him in cancelling his policy.

“On numerous occasions, Mr. Doyle unsuccessfully attempted to cancel his policy by calling the toll-free number listed in the October 24, 2013 letter. Whenever Mr. Doyle called the toll-free number, he encountered an automated call system that would not enable him to speak to a person.

“Frustrated with the significant hold times and inability to speak with a human being, Mr. Doyle contacted his Blue Cross representative, who provided a fax number for Humana which he was unable to locate on Humana’s website.

“On or about November 25, 2013, Mr. Doyle sent a facsimile to Humana providing Human with written cancellation of his policy.

“Humana refused to respond to Mr. Doyle’s written cancellation request.

“On or about January 7, 2014, Mr. Doyle sent a letter to Humana enclosing his November 25, 2013 cancellation request. The letter also demanded that Humana stop deducting the premium from Mr. Doyle’s checking account and return money taken by Humana after Mr. Doyle’s cancellation request.

“Humana refused to respond to Mr. Doyle’s January 7, 2014 letter.

“Plaintiff continued his attempts to call Humana several more times. On or about January 10, 2014, plaintiff was, for the first time, able to speak with an individual after waiting for approximately 20 minutes. But after getting through to a representative, the representative informed plaintiff that the representative did not have the authority to cancel plaintiff’s policy.”

The class consists of all Humana policyholders in the United States who have been billed for insurance premiums on policies which were canceled by Humana on or before Dec. 31, 2013 and/or after the class member tried to cancel the policy.

Doyle seeks class certification, wants Humana enjoined from continuing its practices, disgorgement of profits from the scheme and actual and punitive damages for violations of the Kentucky Consumer Protection Act.

He is represented by Eric L. Dirks with Williams Dirks.

Humana is one of the largest health insurers in the country, with more than $13 billion in revenue in 2013, according to the lawsuit.

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Humana Used Obamacare as Club Against Policyholders, Class Claims

Patients urged to contact Humana regarding decision to cover only one Alpha-1 therapy

One of the country’s largest health insurers, Humana, recently made a policy decision that can adversely affect many people with Alpha-1.

Humana now restricts augmentation therapy for Alpha-1 patients to a single product. The critical therapy is available in four formulations that, as biologicals, are not considered generically equivalent.

Humana and other insurance companies make decisions about what they will reimburse, and publish this information for their insurance beneficiaries in what is called a formulary. This decision by Humana indicates to the Alpha-1 Foundation and Alpha-1 Association what may become a serious trend that will adversely affect all who rely on life sustaining infusions.

Below are ways that Alpha-1 patients and members of the Alpha-1 community can help protect and educate themselves and family members:

SHARE YOUR STORY

Alpha-1 patients and their families are encouraged to share their experiences, especially if you have been or are being required to switch augmentation therapy. Were you forced to switch from an augmentation product you were tolerating well to one you never used before? How might it affect your health and care if you were forced to switch? Have you needed to switch augmentation products because of side effects or other issues? If so, email your experiences to ProtectYourTherapy@alpha-1foundation.org.

KNOW THE PROCESS TO ASK FOR CHANGE

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions. If you choose to appeal a coverage denial, there are several strategies that can bolster your case. Click here for the Appeals and Grievances section of the Alpha-1 Association’s Private Health Insurance Toolkit (PHIT). Click here for Humana’s web portal relating to exceptions and appeals.

URGE HUMANA TO REVERSE ITS DECISION TO COVER ONLY ONE AUGMENTATION THERAPY

Humana’s recent formulary policy decision can adversely affect thousands of patients, including many with Alpha-1, as well as more than 3,000 hospitals and nearly 50,000 pharmacies across the country. Its decision implements a formulary limiting alpha-1 antitrypsin augmentation to one product.

It is simple to take action: contact Jack McKnight, Humana’s director of pharmacy clinical strategies, at jmcknight1@humana.com.

Make sure to state:

  • You are a patient living with Alpha-1 Antitrypsin Deficiency, a rare, inherited condition that can cause serious and chronic lung disease (or liver) disease.
  • There is no cure for Alpha-1 lung disease, but treatments are available.
  • Your treatment consists of weekly IV infusions of alpha-1 antitrypsin derived from human plasma.
  • You have arrived at the product you currently use because it is best tolerated by you and prescribed by your physician.
  • Humana’s recent policy to cover only one augmentation therapy product for Alpha-1-related lung disease may disrupt your current medical treatment and possibly threaten your life.
  • Urge Human to reverse its decision to cover only one augmentation therapy product for Alpha-1-related lung disease.

 

Read complete coverage of the Humana decision, the Foundation’s response and Alpha-1 patient reactions at Don’t Let Insurers Decide.

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Patients urged to contact Humana regarding decision to cover only one Alpha-1 therapy

Not too late for certain Medicare beneficiaries to make changes

Although Medicare’s annual Open Enrollment period has ended, it’s not too late for certain Medicare beneficiaries to make changes for 2014.

Between Jan. 1 and Feb. 14 each year, people currently enrolled in a Medicare Advantage plan who wish to return to Original Medicare can disenroll from their Medicare Advantage plan, return to Original Medicare, and join a Part D drug plan. (In western Nevada County, the only Medicare Advantage Plan in 2014 is the AARP MedicareComplete SecureHorizons HMO.)

If beneficiaries who qualify for the Medicare Advantage Disenrollment Period decide to make this change, their new plan becomes effective the first day of the month following their enrollment request.

Anyone in need of assistance choosing a new plan for 2014 is welcome to make a free HICAP counseling appointment by calling the HelpLine office at 530-273-2273.

HICAP is a nonprofit organization that provides free, unbiased, one-on-one counseling to Medicare beneficiaries, including people who are new to Medicare.

Karin Hofland, Nevada County regional coordinator

HICAP Services of Northern California

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Not too late for certain Medicare beneficiaries to make changes