The article below is a top story from this week's ACTION newsletter—Care Providers of Minnesota's weekly newsletter for members. The newsletter focuses on current legislative issues, regulations, long-term care trends, and other Association news. Each Thursday evening, it is delivered to your inbox. To sign up for ACTION, contact Lisa Foss Olson (952-851-2483). To learn more about membership, visit our Become a Member page.

Requesting Humana Medicare Advantage stories (again)

Patti Cullen
By Patti Cullen  |  January 17, 2020  |  All members

Several years ago, Care Providers of Minnesota, working with our State Health Insurance Assistance Program (SHIP) staff, requested a meeting with the Central North Team for Humana to express our concerns about claims denials and delays as well as the general lack of coverage experienced by Medicare beneficiaries who signed up for one of their Medicare Advantage plans. We received clarification on their processes, contact information for resolution of issues, and a follow-up action step for a change in their claims denial percentages. Based on recent input from some members, it appears it is time again to schedule a meeting with the Humana team and we need your help! We plan on approaching this issue in two ways:

First, the SHIP staff do collect some beneficiary complaints directly, and provide help with appeals. We encourage beneficiaries to send complaints to them as well as to directly file a complaint to Medicare at 1-800-MEDICARE. We have heard from our national team that the Centers for Medicare & Medicaid Services (CMS) does collect the complaints filed at that number and does require responses from the Medicare Advantage plans. We also know some beneficiaries with Humana Medicare plans may have difficulty accessing providers who will accept that plan due to historical non-payment and hope that they also express that concern. 

Secondly, we know members have had experiences with denials of claims submitted to Humana, even if the claims have been submitted timely and “clean.” Please forward examples to us via email, along with the action steps you may have taken on behalf of the Medicare beneficiary to attempt to resolve the denials. It is always helpful to bring multiple examples to these meetings.

Patti Cullen, CAE  |  President/CEO  |  |  952-851-2487

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Care Providers of Minnesota is a non-profit membership association with the mission to Empower Members to Performance Excellence. Our 900+ members across Minnesota represent non-profit and for-profit organizations providing services along the full spectrum of post-acute care and long-term services and support. We are the state affiliate for the American Health Care Association/National Center for Assisted Living, and with our national partners we provide solutions for quality care.

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