HUMANA has a dirty little secret. This secret is now being brought to light. This web page now brings to the surface the dark underbelly of Humana’s policy of neglect and disservice to its member clients. If you or a family member suffers from mental health or substance abuse, you may not find a residential treatment facility in the great state of North Carolina. This is due to the fact that Humana has enacted a company policy of DENY, DELAY, DISMISS when it comes to processing and paying insurance claims from certified, licensed residential treatment facilities. One may ask what a residential treatment facility is. For those who suffer from dual diagnosis of mental health and substance abuse, it is the only house on the block for help. The law requires one must have an address, a residence, to be prescribed mental health medications. This makes sense, since one must be in a stable, safe environment to ensure the medication is properly administered and delivered to the appropriate patient. Secondly, with the co-occurring disorder of substance abuse, the patient has to be free from administering street drugs while taking the mental health medications. The adverse effects could be deadly. Psychiatric medications won’t work if taken with cocaine or methamphetamine. A residential treatment facility is essential because it supplies a safe home for the treatment to be administered.
The residential treatment facility is a small home-like setting where treatment can occur usually for a term of 1 to 2 years, while preparing the client to reenter the community. The residential treatment facility is the best administrative treatment setting available for those who suffer from mental health and substance abuse disorders. These facilities usually have 1 to 5 residents and have a high staff-to-client ratio. North Carolina is one of a few states that have a state residential treatment facility program of certification and licensing. Unfortunately, this is where the state stops. They provide no funding.
However, since the inception of the AFFORDABLE CARE ACT, all insurance companies are mandated to cover mental health and substance abuse treatment. This law in essence passes the funding to the insurance industry. What we have learned, is that just because a law is on the books does not mean it’s followed. Laws are only effective if there is a consequences for not following them. When it comes to the AFFORDABLE CARE ACT, there are no consequences for not following it. In fact, an ALJ judge informed us he can rule over a payment case but has no power to enforce the order. In other words, he cannot make the insurance company do anything. His orders are therefore toothless, and the insurance companies know this. Even after being ordered to make a payment, they can choose not to. The recourse is to then sue the insurance company. However, in our case, the Humana insurance company chose to pay an attorney to dismiss the case.
This represents the final leg of DENY, DELAY, AND DISMISS. We now have the factual paper trail dictating HUMANA’S policy of DENY, DELAY, DISMISS. What we know and can prove is that they begin by first denying the claim. Once we went through the appeal process and got the denial overturned, we then entered the delay process, where, for reasons unknown, the claim just never gets processed. We then asked HUMANA in open court why the claim was not processed for two years. She responded that she did not know why it was not processed. We know why, it’s their policy.
Sadly, after the ALJ judge ordered HUMANA to pay the claim, they chose to pay 6 weeks of a 20-week claim, and with this, they chose to pay a daily rate they set and not the rate ordered by Medicaid/Medicare. We were further dismayed when, after writing the judge regarding this non-compliance, he responded that he could not enforce the order. It would appear insurance companies are above the law.
This makes a mockery of all the hard work done to get the AFFORDABLE CARE ACT across the finish line. Most importantly, it serves as a horrible disservice to all the sick and suffering, who wander the streets as homeless, disenfranchised members of the community. Unfortunately, these souls suffer from a disorder that could end in calamity for themselves or others in the community. When this happens, there is a loud and urgent outcry for more police and thoughts and prayers.
However, the underlying problem is never addressed. The solution already exists; however, due to the corporate greed and callous policies of insurance companies such as HUMANA and their heartless policy of DENY, DELAY, DISMISS we all suffer. Their greed is a plight on society as a whole. The whole mission of insurance is to mitigate the hazards of social plight. The safety net of resources we pay into is being sucked up by HUMANA’s unchecked greed. This company puts its profits ahead of the suffering of the community they are charged to serve.
We are petitioning every conscientious member of our community to spread the word about this corporate example of hazardous and deadly community policy. We must end the ignoring of the AFFORDABLE CARE ACT and make insurance companies such as HUMANA comply with the law of the land. Accountability must be applied to all insurance companies, such as HUMANA. The policy of DENY, DELAY, DISMISS, as it applies to residential treatment facilities and mental health and substance abuse treatment providers, is a disaster and an inconceivable act of corporate greed and a disgrace to social justice. If the law doesn’t apply to everyone, then there is no law. Laws are the social contract of each one of us as the governed. We all agree to submit to the laws of the land to ensure social stability and peace. Without laws and the following of those laws, you have no framework or mortar for the foundation of our society, and thus, society as we know it unravels and disintegrates. We are placing a bright light on this injustice and are actively seeking providers who are like-minded and offended to join our class action against HUMANA for non-payment. Please voice your positive opinion along with your contact information to our email at DDDHUMANA@YAHOO.COM. We ask that if this issue is important to you then BOYCOTT HUMANA insurance until they disassemble this policy of greed and disconcern.
Please feel free to voice your response by sending us your contact info.
