rogermedia
New Member
- 1
Hi all,
My wife and I purchase the 2015 Humana Bronze/Silver ChoiceCare PPO + Children's Dental effective Jan 1, 2015 as we are self employed in our 30's and healthy. The plan lists an individual deductible of $6300 and a family deductible of $12600.
I injured my leg this year and had to have surgery. Prior to surgery we confirmed with Humana over the phone at least two different times that the individual deductible of $6300 would be applied for the procedure.
When we started getting claims the Humana website began tallying towards the family deductible at which time we called Humana for clarification. We were told then that there is an individual deductible and that everything would apply towards the $6300.
Then the claims exceeded $6300 but the website did not indicate that benefits would start kicking in. When we called Humana the representative instructed us to look at the Coverage Details and NOT at the website information, the Summary information, the other reps that we spoke with, or the automated phone menu all of which state that there is an individual deductible of $6300. This rep pointed out that on the Coverage Details the deductible makes no mention of an individual deductible.
We asked her why all of the other pieces of information state that there is an individual deductible and her response was that we should only consider the Coverage Details as fact for the policy. She admitted that if it were her she would be frustrated as well but offered no other help.
We asked for her manager and he was a bit more helpful. He submitted a review to some other department and we should hear something back in 48 to 72 hours.
He pointed out that the Coverage Details have our policy listed as an Aggregate Deductible but that he generally only sees these types of policy's listed as Imbedded Deductibles.
We are hoping that Humana realizes there is some sort of crossed wires occurring here and resolves everything in our favor. If however they come back and say that we are stuck is there any other course of action?
Right now we have screenshots of our Website account that lists our policy as having a $6300 individual deductible. We also have a PDF of the Summary of Benefits and Coverage that also states we have a $6300 individual deductible.
Additionally Humana has the policy for 2016 titles Humana Bronze 6450/ChoiceCare PPO + Children's Dental. In that policy there is an individual deductible of $6450.
It seems like Humana sold us an Imbedded plan but that we got an Aggregate plan. I am posting this to see how we can help ourselves but also to put something out there in case others find themselves in the same situation. If we had not asked for a manager I don't think anything would be happening on our account at this time. I wonder how many other people are confronted with this problem and just give into the rep telling them that they have to accept having a deductible twice as high as what they thought they purchased.
Again we are currently waiting for Humana to review this issue and hope they reply back in our favor. If that does NOT happen what are suggested steps to take next?
My wife and I purchase the 2015 Humana Bronze/Silver ChoiceCare PPO + Children's Dental effective Jan 1, 2015 as we are self employed in our 30's and healthy. The plan lists an individual deductible of $6300 and a family deductible of $12600.
I injured my leg this year and had to have surgery. Prior to surgery we confirmed with Humana over the phone at least two different times that the individual deductible of $6300 would be applied for the procedure.
When we started getting claims the Humana website began tallying towards the family deductible at which time we called Humana for clarification. We were told then that there is an individual deductible and that everything would apply towards the $6300.
Then the claims exceeded $6300 but the website did not indicate that benefits would start kicking in. When we called Humana the representative instructed us to look at the Coverage Details and NOT at the website information, the Summary information, the other reps that we spoke with, or the automated phone menu all of which state that there is an individual deductible of $6300. This rep pointed out that on the Coverage Details the deductible makes no mention of an individual deductible.
We asked her why all of the other pieces of information state that there is an individual deductible and her response was that we should only consider the Coverage Details as fact for the policy. She admitted that if it were her she would be frustrated as well but offered no other help.
We asked for her manager and he was a bit more helpful. He submitted a review to some other department and we should hear something back in 48 to 72 hours.
He pointed out that the Coverage Details have our policy listed as an Aggregate Deductible but that he generally only sees these types of policy's listed as Imbedded Deductibles.
We are hoping that Humana realizes there is some sort of crossed wires occurring here and resolves everything in our favor. If however they come back and say that we are stuck is there any other course of action?
Right now we have screenshots of our Website account that lists our policy as having a $6300 individual deductible. We also have a PDF of the Summary of Benefits and Coverage that also states we have a $6300 individual deductible.
Additionally Humana has the policy for 2016 titles Humana Bronze 6450/ChoiceCare PPO + Children's Dental. In that policy there is an individual deductible of $6450.
It seems like Humana sold us an Imbedded plan but that we got an Aggregate plan. I am posting this to see how we can help ourselves but also to put something out there in case others find themselves in the same situation. If we had not asked for a manager I don't think anything would be happening on our account at this time. I wonder how many other people are confronted with this problem and just give into the rep telling them that they have to accept having a deductible twice as high as what they thought they purchased.
Again we are currently waiting for Humana to review this issue and hope they reply back in our favor. If that does NOT happen what are suggested steps to take next?
