Why Humana’s Pharmacy Insurance Needs An Overhaul

 

humana customer service

My mind-numbing experience throughout the past week screams, ” Why Humana’s Pharmacy Insurance Needs An Overhaul.”

I have taken the prescription medication, Nuvigil for almost a decade and I believe Humana has been pharmaceutical coverage throughout this time.

My latest frustration with the Humana Pharmacy Program begins last Friday when I arrive at my local pharmacy to purchase my Nuvigil refill.

The soft-spoken, female, twenty-something pharmacy tech informs me that my Humana Prescription coverage has denied my Nuvigil refill.

I reply, what and then, why?

The pharmacy tech and the pharmacist sort out why Humana denies my Nuvigil prescription.

The pharmacist politely ends our conversation when she prints and highlights the reason why Humana Insurance has denied my Nuvigil refill.

Ugh… Really?!

I inform the pharmacist that I am out of Nuvigil.

The compassionate pharmacist tells me I can purchase a week’s worth until I can untangle my Humana Insurance.

The pharmacist then quotes me a price tag of almost $300.00 for a week’s worth of Nuvigil.

My mind spins, and then screams, this is not right, nor is it fair.

Why Humana Pharmacy Insurance Needs An Overhaul

  • No notification of cancellation
  • Needs to be located in the United States instead of Jamacia
  • Have a clearly printed phone number for the Clinical Review Department

Humana’s Pharmacy Program did not give me notice that they were rejecting my Nuvigil refills.

I understand that the expensive prescription medication Nuvigil may need Prior Approval.

However, my doctor successfully submitted a Prior Approval for Nuvigil about 90 days ago.

Due to Humana’s lack of consistently I assume, there must be a mistake.

I step aside from the pharmacy line and phone Humana’s 800 number.

After I phone the Humana Pharmacy number, I am prompted to say my id number, my date of birth, and what department I need.

Of course, after, two rounds of the taped message, please type in your information from your phone keypad, I am frustrated.

A pleasant Humana Customer Service Representative listens to me convey my frustration and then she disconnects me.

I have to begin my call to the Humana 800 phone number again.

Five minutes later I am speaking to another kind spirited lady from Humana’s Customer Service.

This woman informs me that I need a Prior Authorization for the Nuvigil.

I say, what?

Yes, you need a Prior Authorization.

I announce that the Nuvigil had a Prior Authorization about 90 days ago.

The Humana Customer Service Representative informs me that I need a new Prior Authorization every calendar year.

 I reply that this protocol has not been my prior situation, and this Humana subjective ruling does not appear fair.

I then go on to ask the customer service woman if I had a Prior Approval for this medication towards the end of December would I need a new Prior Approval two weeks later?

The customer service representative compassionately tells me yes.

Of course, I say, that subjective ruling by Humana is not fair, the rule is dangerous and negligent.

My frustration levels grow as I mention to the Humana Customer Service woman that I am out of Nuvigil.

I go to say; I do not understand how a large publicly traded, health insurance corporation such as Humana does not provide any notification about discontinuing my Nuvigil refill.

The customer service representative agrees with me.

The Humana representative suggests I purchase the Nuvigil and then try to have Humana reimburse me.

Really? I remark. I make the representative aware that my Nuvigil prescription is over $800.00 a month without health insurance.

If I do not take this medication I will not die but my mind would go off the deep end, and I will become extremely fatigued.

Life choices.

The Humana representative then suggests that I have my doctor immediately complete the Prior Authorization or go to the doctor’s office and pick up some Nuvigil samples.

Exasperated, I reply to the customer service representative that my doctor does not work Friday’s, Nuvigil is not a sample pack medication, and it is not that easy to obtain an appointment with a specialist.

Sympathetically she advises me that she is going to do me a huge favor and connect me to Clinical Medical Advisory.

She advises me that the Clinical Review Advisory can overturn my Nuvigil denial.

I thank the Humana customer service representative.

I think to myself; she is doing her job.

I do not believe it is a huge favor that she is willing to connect me to the correct department.

However, I am not connected.

My phone call is disconnected!

I rinse, repeat, go through the Humana 800 phone system. It is now after 4:00 P.M. on Friday.

When my phone call finally arrives at the Humana Clinical Review Advisory, I am greeted by a woman with a thick accent.

The woman’s English is fragmented and extremely difficult to comprehend.

I find it unbelievable that the woman on the other side of the phone has the power to control the outcome of my healthcare.

I ask the woman for her name, and then I ask her the venue of the Humana Clinical Review Advisory.

She says her name, but I do not entirely make out the correct pronunciation.

I ask her to please spell her name for me.

Even as she spells her name, I do not understand all the letters of her diction.

Then, this woman says, Jamacia.

Stunned, I question the woman that the Humana Clinical Review Advisory for the United States resides in Jamacia.

The woman, says yes.

This woman, I will call her Cassandra then asks me to wait on hold as she goes through my file.

Of course, I reply.

I wait, I wait, and finally, she tells me you are all approved.

Fabulous! I convey.

I ask her to wait on the phone with me as I speak to the pharmacist.

The pharmacist double checks my Nuvigil status and tells me that Humana is still denying my Nuvigil.

I ask Cassandra why she told me my Nuvigil was approved.

She says, oh.

Cassandra then proceeds to click onto her computer screen.

Cassandra then tells me that she had the wrong file open.

I ask to speak to a manager.

She tells me there are none available and then hangs up on me.

Fast forward to Monday I see my doctor has submitted a Prior Authorization to Humana Pharmacy by 6:30 AM PCT.

After I note my specialist Prior Authorization in Humana system, I attempt to reach Humana’s Clinical Review Advisory.

It takes me a few tries but finally I connect with Humana’s Clinical Review Advisory.

As luck would have it, Cassandra answers my call.

My tone is not upbeat. I advise Cassandra that she did not provide me with assistance, she would not transfer me to a manager and then she hung up on me.

I firmly state I would like to speak to a manager.

Cassandra transfers my call to a woman manager named, Petta.

Rinse, repeat, I go over my prescription history with Petta.

I note to Petta that my Nuvigil was approved a little over 90 days ago and the drug Humana wants me to change to I have already tried.

Unfortunately, the formulary prescription gives me migraines.

All this information is in my prescription history.

Petta promises to phone me back on Monday, and she keeps her words.

Unfortunately, even with all my updated information she still does not have an answer.

I ask Petta if the Humana Clinical Review Advisory has United States M.D., D.O., and medical specialist making these decisions in Jamacia.

Petta chuckles and says, of course.

She goes on to say, that they are a United States based company.

I say to Petta, Humana Clinical Medical Advisory may be U.S. based but it is located in Jamacia. 

Petta promises to phone me Tuesday morning, and she does not.

I check my Humana Prescription Portal and note that a Nuvigil denial is next to my doctor’s new Prior Authorization.

Tuesday, January 22, 2019

I make an appointment with my doctor.

I need to have my doctor assistance with my Nuvigil Humana prescription.

I am exhausted, fatigued from my lack of Nuvigil I convey my Nuvigil prescription story to my doctor.

She has been my doctor for over fifteen years. She knows how much Nuvigil helps me.

My doctor informs me that she will help with any Humana appeal.

My additional doctor’s visit is costly.

My doctor is out of network, so Humana has caused me to incur other costs.

Brain fogged, fatigued and feeling bouts of depression engulfing my body I decide that it is negligent to go cold turkey from Nuvigil.

My medical costs make up a large portion of our family budget.

Sadly, this month the cost from my Nuvigil will cause additional financial pressure.

Unfortunately, this is not the first time I have experienced difficulties with Humana Prescription Plan.

My other doctor had to battle with Humana to provide me with the daily life-saving medication I need.

The actions from the Humana Clinical Medical Review caused my doctor to write to Humana that I will die without this medication.

It is a blessing that medication has been able to hold off some of the effects of my collapsing body.

I purchased health insurance, prescription coverage so our family’s financial well-being would not have to collapse too.

Health insurance is complicated, but it is unfair that the sick pay into a system that is frequently subjective.

Insurance companies have already measured my risk into their insurance rates.

WHY I NEED NUVIGIL

I have Sheehan’s Syndrome a.k.a. Hypopituitarism

What is Hypopituitarism?

The pituitary gland does not release the life-essential hormones that the body needs to survive.

What Causes Sheehan’s Syndrome?

The rare disease Sheehan’s Syndrome is a disease that affects the function of the pituitary gland and is caused by severe blood loss during or after childbirth. The loss of blood to the pituitary gland may destroy hormone-producing tissue. When necrosis of the pituitary gland occurs the pituitary may lose some or all of its function.

The Pineal Gland

The Pineal Gland is about the size of a grain of rice. 

Similar to the Pituitary Gland the blood barriers do not protect the Pineal Gland.

Like the Pituitary Gland, the Pineal Gland can stoke-out from loss of blood.

The Pineal Gland is responsible for our wake, sleep cycle.

Every day I swallow a handful of medication that tries to mimic what my body would produce naturally.

It is a balancing act that is often not successful.

My sleep and wake cycles do not work.

I sleep and wake at the incorrect times, and my body is extremely fatigued, depression rages without the Nuvigil medication.

There are numerous medical articles about the relationship between the pineal gland and the pituitary gland.

https://www.sciencedirect.com/science/article/pii/0306453083900422
https://en.wikipedia.org/wiki/Pineal_gland

HUMANA’S STOCK PRICE

Humana is a hugely profitable corporation.

In the last five years, Humana’s stock price has tripled.

February 3, 2014, Humana’s stock was at $95.75, and today Humana stock closed at $300.53.

humana stock price

Thanks to Obamacare Humana and other significant health insurance corporations have watched their profits soar.

Heavy tax fines for those who do not have health insurance contribute to health insurance profits.

The more people buying health insurance premiums equates health insurance profits.

 

HUMANA’S CORPORATE OFFICERS PROFITS

Below is a snapshot of several of Humana’s key executives.

You can note that Mr. Bruce Dale Broussard, Humana C.E.O. brought home a $19 million dollar paycheck.

$4.3 million was salary, and the remaining portion of the 19 million was gained from Broussard exercised stock options.

I am not against profit, but does Humana need to have their Medical Review Board in Jamacia?

WHY I STAY WITH HUMANA INSURANCE

Humana pharmacy insurance provides me with life-saving medication.

I am grateful.

I would rather deal with an insurance company I know than gamble with new health insurance.

Having a chronic illness is a full-time job, it leaves little resources to battle for medication I desperately need.

It is time for Humana Pharmacy Insurance Program to make some changes. 

My note to Humana; profits should not be made because customers are not able to phone you, appeals are not easy, your customer service representatives do not know or comprehend the company’s protocol. Humana because you are a U.S. based company it would be greatly appreciated it your Medical Review was also located in the United States.