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:


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


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.


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

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

Minnesota attorney general asks U.S. to investigate Humana

Karen MerrickMinnesota Attorney General Lori Swanson said patients and doctors are having “significant problems” with Humana.

Minnesota Attorney General Lori Swanson is asking the federal government to investigate Humana’s Medicare Advantage policies after uncovering what she said were “significant problems” reported by Minnesota patients and medical providers.

Affidavits gathered from 25 Minnesotans showed a pattern where Humana denied claims for medical services required by law, overcharged for co-payments and coinsurance, and failed to disclose the providers that are in the network, she said. Swanson’s office also found that Humana didn’t follow procedures laid out by federal regulations for patients to appeal their cases.

“They were stringing people along, taking months to get back to people,” she said. “Oftentimes, it took the intervention of our office — and oftentimes we had to write multiple times.”

Humana, based in Louisville, Ky., is one of the nation’s largest health care insurers in Medicare Advantage, a private policy that covers seniors and those with disabilities. Humana has been doing business in Minnesota for more than 10 years, and provides insurance coverage to more than 100,000 residents through various types of Humana Medicare Advantage plans, including a plan for prescription drugs, according to a company official.

Humana spokeswoman Kate Marx said in an e-mail that the insurer has not been notified of the complaint by the Minnesota attorney general’s office or by federal regulators.

“We take this very seriously and are working to identify the facts,” Marx said.

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Minnesota attorney general asks U.S. to investigate Humana

MN Attorney General Asks Feds To Investigate Humana

ST. PAUL, Minn. (WCCO) – Minnesota Attorney General Lori Swanson says a federal investigation is needed to look into business practices at one of the nation’s largest private Medicare insurers.

On Friday, Swanson sent a massive file of complaints against Humana to the federal agency charged with overseeing that part of Medicare.

She’s asking the Centers for Medicare & Medicaid Services (CMS) to look into more than 27 complaints on file.

For the past couple of years, Humana policy holders in Minnesota have complained of improper denial of coverage, overcharges for co-payments and failure to follow the required appeals process.

Kentucky-based Humana provides private Medicare insurance coverage to more than 100,000 Minnesota seniors.

This investigation into Humana’s alleged wrongdoing has been going on for a couple of years, Swanson asserts. It stems from both consumer and medical provider complaints from across the state.

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MN Attorney General Asks Feds To Investigate Humana


Minnesota Attorney General Lori Swanson today asked the federal agency responsible for regulating private Medicare insurance policies to investigate and remedy complaints by Minnesota senior citizens about improper claims handling by Humana, which sells private Medicare policies in Minnesota.

In a letter containing over 25 sworn affidavits from Minnesota patients and medical providers, Attorney General Swanson called on the federal Centers for Medicare & Medicaid Services (“CMS”), which regulates private Medicare plans, to investigate and remedy any violations of federal regulations arising from Humana’s improper claims handling in Minnesota. The United States Congress has determined that states are preempted from regulating benefit determinations of private Medicare Advantage plans and has vested jurisdiction to regulate such plans with CMS.

“Medical bills that aren’t covered or processed properly can hit senior citizens hard in the pocketbook. We are asking the federal agency that has authority over these plans to fully investigate and remedy the problems experienced by Minnesota patients,” said Swanson.

Medicare Advantage plans are private health plans approved by CMS, but sold and administered by private insurance companies as an alternative to traditional Medicare fee-for-service coverage. Medicare Advantage plans may provide prescription drug coverage and include mandatory or optional supplemental benefits such as vision and dental benefits. Minnesota has the highest number of enrollees in Medicare Advantage plans in the nation on a per capita basis, according to a June 2013 report by Kaiser Family Foundation.

In her letter, Attorney General Swanson cites numerous problems reported by Minnesota patients and providers about Humana, including:

  1. Denial of claims involving Medicare-covered services. (Other than hospice care, Medicare Advantage plans must cover anything traditional Medicare would cover.)
  2. Overcharges for co-payments and co-insurance.
  3. Failure to adequately disclose what providers are in network and to update its network provider directories.
  4. Failure to follow the appeal procedures required by federal regulations.

Humana is a publicly traded, for-profit insurance company. It is one of the biggest insurers in the Medicare Advantage market nationwide, offering at least one type of Medicare Advantage plan in all 50 states. About 17 percent of all Medicare beneficiaries nationwide are enrolled in a Humana Medicare Advantage plan, according to a June 2013 report by Kaiser Family Foundation.

The Attorney General’s Office provides this advice to Medicare beneficiaries who are thinking about enrolling in an Medicare Advantage plan:

  1. Determine if your health care providers are in-network.
  2. Identify the copays, deductibles, and out-of-pocket maximum costs for the plan. Plans’ costs will vary, especially for in- versus out-of-network care.
  3. Determine if supplemental benefits are offered by the plan.

People may report complaints against Humana to the Minnesota Attorney General’s Office by calling (651) 296 3353 or (800) 657 3787. Individuals may also download a Complaint Form from the Attorney General’s website by clicking here and mail the completed form to the Attorney General’s Office at: 1400 Bremer Tower, 445 Minnesota Street, St. Paul, MN 55101 2131. People should also contact CMS directly about this problem by calling CMS at 1-800-633-4227 or by writing to its Administrator, Marilyn Tavenner, at Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.


Minnesota wants CMS to investigate Humana’s Medicare Advantage plans

AG Lori SwansonMinnesota Attorney General Lori Swanson is asking the CMS to investigate Medicare Advantage plans offered by Humana and has presented regulators with more than 25 affidavits of complaints from beneficiaries.

The affidavits allege, for instance, that Humana denied reimbursement for services that it is required to cover for all Medicare beneficiaries—including diagnostic ultrasounds, mammograms and care in a skilled-nursing facility for a stroke patient.

The letter also said, among other complaints, that the Louisville, Ky.-based insurer created confusion by not adequately disclosing which providers were in-network and does not comply with required appeals processes.

The complaints come at a time when the popularity of Medicare Advantage plans has been escalating. And Minnesota has the highest percentage of Medicare beneficiaries enrolled in an MA plan, at 49%—compared with 28.8% of beneficiaries nationwide, the letter said. Humana has 17% of the Medicare Advantage market in Minnesota, according to Swanson’s office.

Swanson wrote that she was asking the CMS to pursue an investigation because states do not have the authority to enforce Medicare Advantage plan rules and make benefit determinations.

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Minnesota wants CMS to investigate Humana’s Medicare Advantage plans