"$34 Billion Dollar health care mega conglomerate steps on hapless consumer>>standard form response:'...claim is without merit,case closed,......all perfectly legal', says HUMANA-- -- --- -Humana GOOSE RETURNED TO PEOPLECLAIM KITCHEN(UNDERCOOKED)-- -- ---
re: doctors visit(05/05/14),Dr.Charles U.Delatore,Brown & Toland co-payee doctor
This is in regards to my initial visit to Dr.Delatore(claim #: 98316 5723) last year. After I left, I decided this doctor was not meeting my needs(I came in for a prostate problems,he gave me a referral for further psychiatric evaluation?), & I subsequently never came back. Imagine My shock when I received your medical benefits statement, & saw he padded(charged) me, excuse me, he billed MEDICARE for a $560. I immediately contacted Humana, & they responded: 'He charged you $560 for a urinalysis, claim is without merit.' I do not recall him asking me for a urine sample(common procedure in prostate exams). Instead he scheduled me for a later appointment for blood tests with a psychiatrist. In deference to Brown & Toland, I will leave that as their option(contacting the party in question). I was not a little bit upset( I came in seeking treatment for one thing[excessive urination,possible prostatitus] ,only to be told to go see another doctor for something else. In deference to HUMANA, if you are going to accuse these HMOs of this type of activity, you're going to have to accuse probably 98% of the physicians in North AMerica who participate in health plans that contract w/ the federal gov.(MEDICARE). Most physicians will probably be confronted w/ this situation at least once in their careers, as this is a widely condoned method of remuneration for 'medical services rendered.'
I would also like to share w/ viewers of my posts, some miscellaneous observations,in no particular order:
1. Most of these lower-echelon clerical staff that handle my policy,or even my complaints if they arise, are basically, not licensed physicians. That is to say, they are employees of a company, that just happens to be in health care,so although they are well versed in medical terminology,they cannot open investigations,they have no legal jurisdiction over these cases of patient abuse,& they certainly don't have any input into the decision making policies of Humana.
2. There is an inverse relationship between the size of these big box HMOs: Aetna, Anthem,United Health Group, Humana, & the probability that you will get a response(resolve your complaint in a timely manner)[Now going on 16+ months & counting, w/ no end in sight]>>other than there standard response:'...claim has no merit, case closed.
-- --IT'S THE HOMEOWNER'S RESPONSIBILITY TO 'POLICE' HIS HOME FOR STOLEN ITEMS,NOT THE POLICE.'-- --
I understand their position,that unless the patient calls them out,they are not responsible for investigating complaints.['..if we don't see it, it didn't happen.'] .This is not so much a legal maneuver, in so much as a somewhat sensible accounting technique(they cannot afford to commit resources & countless hours of paperwork to investigate each & every claim,however insignificant). If you take that analogy to a homeowner whose home is burglarized, a lot of times, homeowners frequently do not file criminal reports, for reasons unknown?( they may be out of the country, incarcerated, or even unaware that a crime has been committed).In other words, the police will not intervene,& unless the homeowner reports the crime,& the police arrive to take a statement, only then will they undertake an investigation, & steps to detain, apprehend, or arrest the suspect. It saves resources to devote to actual crimes that occur. Nevertheless, I decided to file anyway(?).
.. ..As with shopping website, AMAZON,resellers are 'independent contractors', not AMAZON employees, AMAZON disavows any 'financial,or legal culpability for losses incurred due to the use of its INDEPENDANT CONTRACTOR 'doctors'....
sincerely,
I realize this is haggling over technicalities, but sadly, this will not be my last encounter w/ these types of grey areas. Medical ID#H49568 790.. ..( I am not an attorney)"