I'm a 54 yo who had been on Medicare since 2006. Upto this year ANTHEM BC offered a PPO plan in my area this year I had to switch to a MAPD HMO plan. Unfortunately my agent recommended Humana Gold plus plan. I communicated to him that continuing with my treatments with my specialist were of utmost importance during plan selection and comparisons. We simply searched for my specialists in Humana's provider directory. They were supposedly in. Then one by one I had been refused services. They placed me into an IPA connected to my PCP, that made all my specialists out of network. We tried to change IPA to one that would include my specialists. Humana refused to change IPA w/o changing specialists. Then a joint conference call among me, my agent, and Humana revealed there not existing an IPA that contained my PCP and my specialists. Either pick PCP or the specialist I needed the most, I had been advised. In the meantime Humana changed IPA for my PCP to the same one, next month to one that did not include any of my specialists, rendering the authorizations they had aready gotten useless.
My questions:
(a) this IPA assignment based on PCP in a way to stop access to one's specialists. Is that a common HMO practice, is that Humana's way of disserving its members? Should not my agent has been cognizant of IPA angle and steer me into finding a PCP that would have allowed me to continue medical treatments of my specialists.
(b) if my specialist obtain authorizations from IPA, would that authorization step need to be repeated for each visit, each treatment? Does authorization imply Humana will cover the medical expenses?
(c) since mid Jan I have been trying to get Humana change my IPA associated with my PCP, one time they reported having changed it but it was left the same, next time they changed it to some other IPA that had no relationship to the IPA I requested. Finally I requested from them to change my PCP and my IPA so I could see as many as my specialists as possible. This time they claim hey can't make the change until April, even though the requests is datetime stamped as Feb 28th.
(d) in all this never ending PCP+IPA selection, I had seen a couple of specialists. Their bills had been sent to me. The price tag being much higher than the price tags agreed between Doctors and networks.
(e) Do you see agent error here? If so, could it allow me to change my MAPD plan & carrier.
My questions:
(a) this IPA assignment based on PCP in a way to stop access to one's specialists. Is that a common HMO practice, is that Humana's way of disserving its members? Should not my agent has been cognizant of IPA angle and steer me into finding a PCP that would have allowed me to continue medical treatments of my specialists.
(b) if my specialist obtain authorizations from IPA, would that authorization step need to be repeated for each visit, each treatment? Does authorization imply Humana will cover the medical expenses?
(c) since mid Jan I have been trying to get Humana change my IPA associated with my PCP, one time they reported having changed it but it was left the same, next time they changed it to some other IPA that had no relationship to the IPA I requested. Finally I requested from them to change my PCP and my IPA so I could see as many as my specialists as possible. This time they claim hey can't make the change until April, even though the requests is datetime stamped as Feb 28th.
(d) in all this never ending PCP+IPA selection, I had seen a couple of specialists. Their bills had been sent to me. The price tag being much higher than the price tags agreed between Doctors and networks.
(e) Do you see agent error here? If so, could it allow me to change my MAPD plan & carrier.
