The company was cited twice in 1989 by Health Care Financing Administration officials for violating several payment regulations.īoth times the agency ordered Humana to correct problems ranging from short- changing non-affiliated doctors who treated Gold Plus members to improperly denying patients' claims. The Gold Plus Plan's claims processing has been a source of irritation to federal regulators, records show. ![]() A claim for $26,000 was turned down for lack of authorization - even though the 69-year-old man had died in a New Jersey hospital after a massive stroke, records show. One 83-year-old man's $515 claim was rejected for care he received aboard a Caribbean cruise ship. ![]() ![]() "In any HMO there is a financial incentive to hold back on services," said Dale Abrahamson, a nurse who directs quality assurance for Humana health plans in South Florida.īut Humana officials insist that many sl and youthful-looking woman, concedes that she did not follow the HMO's rules. The HMO's 216 centers in South Florida are mostly run by private doctors who benefit financially from keeping high- priced health care to a minimum. ![]() At least 114 Gold Plus members have charged that the health plan deferred necessary medical treatment too long or restricted trips to specialistsmembers in the three-county area.Ĭompany officials acknowledge some problems with paying bills quickly and making sure members get prompt care. Humana eventually paid the bills in 72 percent of these cases, but only after pressure from state insurance officials and months of uncertainty for patients. At least 503 Gold Plus Plan members have filed complaints with the Florida Department of Insurance since 1988 charging that Humana improperly declined to pay their medical bills, including emergency services.
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