Rogelio Gjm

The worst ever

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Im not sure what changes have happened to their administration, but this program is the worst ive seen in the military. Im trying to find a dam doctor and all their info are completely wrong, and when i tried calling I get a dam computer with no access to an operator. Wth is wrong with you, stealing money from soldiers and making the process for everything difficutllt so we end up paying the bills.
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4 comments
Guest

Tricare went to a new contractor, Humana, as of January 1, 2019. As a healthcare provider and a beneficiary, they completely lack the skills and knowledge.

When Healthnet was the contractor it was not this bad. Three months in a row I've had to call TYA to give them updated credit card information. Each time I've called they have confirmed that they have my information, yet each month I am receiving a letter stating my credit card information is not correct.

Finally talked with a supervisor today who fixed the problem for me while I was on the phone. Also when my daughter turned 23 and I called them asking what to do, they gave me three different ansers.

Guest
reply icon Replying to comment of Guest-1647827

This is just factually incorrect, even of the first sentence. Humana-military has been the contractor for Tricare coverage for various regions for many years. Get your facts straight before you whine.

Guest

They always have customer service agents at the ready Monday - Friday 8 AM- 6 PM, Did you Try pressing zero or listening closely to the prompts? Here, if you need it is a prompt that helps you through the automated system http://apps.humana.com/marketing/documents.asp?file=264**** try again yo

Guest
reply icon Replying to comment of Guest-1638194

You think, I wasted my time writing this review because what you are saying it's TRUE. You must work for them.

I've almost Die at the hospital because I've waited to find a Dr and I still haven't.

There is no dam operator in the other end. If there is she was on vacation that week.

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Anonymous

Servers constantly down & Horrible customer Service

I have moved and need to see a doctor. The server has been down since Monday. Today is Wednesday and I was told nothing can be done. Unbelievable that veterans get such horrible service. Tricare should be ashamed. "Every time" I call it is a horrible experience.
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Anonymous
map-marker Fort Huachuca, Arizona

Tricare is worthless to retiree

When I turn 65, I'm losing my Tricare, Why because when I sign up for Medicare I'm only getting part A, because I am still working and have Blue Shield/Blue Cross high end coverage and do not need Part B. I was going to get Part B till I found out I would have to pay 300.00 per month because I took funds out of a retirement fund to help pay for home improvement that add to my yearly income. I went to SSA administration and told them but it doesn't matter to them or the military. Anything to screw over retiree's and veterans.
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5 comments
Guest

I have been reading these complaints and understand. What I dont understand is why this person keeps posting in these serious threads and scared to say who they are. If you have so much opinions about those stating there reviews...show up, show your name, and state why you feel how you feel.

Guest
reply icon Replying to comment of Guest-1699335

says the person posting anonymously

Guest
reply icon Replying to comment of Guest-1700747

Anonymous is replying to everything with his wisdom. Oh why can’t we all be like Anonymous. I think he or she is probably someone even Jesus would have a hard time loving.

Guest

don't follow the rules don't get the coverage grandpa didn't the military teach you that you have rules you have to follow? where is whining going to get you?

Guest
reply icon Replying to comment of Guest-1683930

Oh *** yo this guy got a point

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suzanne S Fvf

An inept and inefficient and terrible customer service insurance

Our clinic has been trying to get claims paid by the horrible Tricare for months now. Some of the denials are totally erroneous, and when we finally get to speak to someone at Tricare, they agree. Unfortunately, that has not helped to get the claims paid. We are in a process of trying to get our Senator to help us get these claims paid. Unfortunately, the HIPAA regulations are stopping that process from happening because the patients' are on active duty and do not get their mail or emails frequently. And, do not blame them for not wanting to fill out more forms that they should not have to fill out in the first place! Really need someone to go after Tricare. Other military insurances are bad too. They are extremely slow. What is going on?
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Reason of review:
Problems with payment
1 comment
Ashlyn Flp

Hi, I work in the insurance department in my clinic too. I have been searching for anything online to let me know we are not the only office having these massive issues with Tricare.

I'm at a loss for words and not sure where to turn. Every time I call Tricare I am told something different. Not only are claims being denied in error, but they are paying some claims more than once. Which in turn then they request the money back.

They hold this money out as an off set on our EOB, BUT THEY DO NOT TELL US WHICH PATIENT THE MONEY CAME FROM. I don't see how you can legally hold money back and not tell the providers where it's coming from.

I've had numerous issues with them and these I've mentioned barely scratch the surface. I'm curious to know if you have any update?

Jessica H Eks

Humana/Tricare doesn't care to help

Tricare has rejected payment of a medical bill from the birth of my daughter. They have stated that she was not covered at the time because she was not enrolled properly. My husband and I did the steps of enrollment and, due to a Tricare error, my whole family was disenrolled. Following, I made contact and initiated reenrollment. However, they did not properly enroll my daughter. This error has resulted in years of stress and loss of money for my family. This is Tricare's responsibility, but due to the transition of healthcare to Humana this issue is not being resolved- at this point it is negligence. I have contacted Humana, DEERS and Tricare in numerous attempts to resolve this and yet no one takes responsibility. It is impossible to actually make meaningful progress on this because inept communication/information processes for relaying any complaint. It seems that all complaint resolution processes are purposefully circular and designed to delay resolutions. This convoluted process does not allow for consumers to actually have any voice and therefore, skews the complaint process in favor of Humana and, as such, provides consumers no viable avenue for complaints.
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Loss:
$4
Cons:
  • That they are not taking responsibility for their mistake
Reason of review:
Poor customer service

Preferred solution: Full refund

2 comments
Guest

seriously? 4 dollars?

Guest
reply icon Replying to comment of Guest-1657779

Hello! It was supposed to say $4000.00.

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Anonymous

Worst to deal with

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We have had 60 plus non network applications sent over since July 2018 that still have not been processed even though current ones are being processed. When you call, chat and email they are of no help and don’t seem to know who we should speak to get these applications escalated. We are close to the timely filing which we will run into having to write claims off because of this. When Healthnet handled the north region there was never issues like this. Please get this fixed. They are horrible to deal and can be unpleasant at times.
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Reason of review:
Poor customer service
Kellon K
map-marker O Fallon, Missouri

Bills In Collection

Called Tricare on February 11th in regards to a healthcare bill in collections. Tricare said I needed to fillout a form but the only way to receive the form is in the mail (its 2019 wtf). I also contacted the hospital the same day about said bill. I received the bill from the hospital the next week. Tricare? Its March 4th and I still havent seen the 'form' yet. Meanwhile the bill sits in collections. My credit? Torpedoed by a bill that was suppose to be paid for by my 'superior' health coverage cause im in the military. Called tricare again today to have the form sent to me (again). After asking multiple questions I got off the phone. Only to call back 10 minutes later and let them know I will be writing my congressman.
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Loss:
$955
Reason of review:
Poor customer service

Preferred solution: Deliver product or service ordered

Torrie P
map-marker Louisville, Kentucky

Disabled Vet and Family insurance cancelled due to Humana

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I am a Veteran that spent over 20 years serving my country, and I just found out my tricare that I serve 24 years to earn have just been cancelled. The Humana representative I talked to most have not been a veteran because they were not very concerned or helpful. Because they had a rate increase and never notified me, my coverage expied in August. Although I updated my information in several Tricare systems, and have been seen by them they did not have my correct email address or mailing address on file. Due to this mistake (of Humana) I will not be covered by tricare, which I no doubtly EARNed every bit. This company is a fraud, and horrible that they have a monopoly that are mistreating veterans.
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Loss:
$999999
Cons:
  • Customer service
Reason of review:
Return, Exchange or Cancellation Policy

Preferred solution: Deliver product or service ordered

Kenneth M Xof

Over All Poor

On two different occasions I arrived at a medical appointment only to be told Tricare had cancelled me with no notice or warning. Both times they claimed I had not made my payment, both times I had. In fact it was set up for auto draft. After the second time I faxed a bank statement showing I had paid and again saved up for my two month premium to reinroll. The last time they would not allow it because I was cancelled for non payment. They claim I had not sent the fax. I now have a family of four to attempt to find good, reasonably priced, medical insurance for.
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Heather C Nzj
map-marker Louisville, Kentucky

HUMANA - WPS clueless about claims processing

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Yes, many providers have stopped accepting Tricare because of the mess that Humana has created by changing to WPS as their claims processor. Humana was actually great when PGBA was processing claims for the south , they were in control of the website, and handled eligibility.

PGBA knew what they were doing and we never had any issues! WPS not so much, 75% of our claims are processed incorrectly so we are having to be on the phone 2-4 hours a day trying to get them corrected only to be processed incorrectly again. WPS claims reps have no clue what they are doing and are very rude. I have tried to get help from our provider rep.

( I was told that provider reps. are supposed to help providers) but never could get in touch with her after several e-mails and phone messages. I have tried calling corporate and get transferred to another person that has no idea what to do. I sent a letter to the grievance department at Humana and have never heard anything back.

This issue is because Humana changed claims processors to WPS...…..

WAKE UP HUMANA!!! YOU have FAILED your Tricare members and providers!!!

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Loss:
$15000
Pros:
  • It better before the most recent change in managing companies
Cons:
  • Most everything
Reason of review:
Poor customer service

Preferred solution: Have someone who can actually do something to correct the way claims are being processed.

7 comments
Guest

It is horrible . I am still waiting for 3 claims --- sibmitted in Feb.

and March of 2018. Doctor submitted them all twice. Still no response.

Doctors are dropping TRICARE because they are not getting paid. And patients are left paying for he full bill.

Guest
reply icon Replying to comment of Guest-1587060

if you pay full bill you can file claim with Tricare for re-imbursement. also probably don't use that doctor again.

Guest
reply icon Replying to comment of Guest-1587774

Why would a patient want to pay out of pocket when they have insurance? its not the doctor, its the claims processor.

These doctors have been billing the same claims with Tricare for several years.

never had a problem till WPS took over. That should tell you something......

Guest
reply icon Replying to comment of Guest-1587774

Your response to all the incompetence is a joke, which call center or claims processing center do you work at? Why would a patient need to pay the full bill then submit to insurance?

That's what contracted providers do and it works just fine if the people processing the claims know what they are doing.

It has nothing to do with the doctor or how they are billing. It has everything to do with CLAIMS PROCESSORS.

Guest

claims process fine if they are submitted right.

Guest
reply icon Replying to comment of Guest-1586980

You are too funny! You must be one of the processors. I have over 100 claims that have been processed incorrectly.

Guest
reply icon Replying to comment of Guest-1586980

Not true

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Elizabeth M Dno

Denied prescription for serious infection

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I have a serious infection of my small intestine, SIBO, verified by medical tests. (Paid for out of pocket) My doctor determined that I am in need of a strong prescription of a drug called Xifaxan to treat this infection, but the coverage has been denied. When I finally got a representative from Express Scripts to answer the phone and check on the claim, she told me that it had been denied because I had not first taken a prescription for a trip-cyclic anti-depressant. Well, excuse me, but I have NEVER been depressed, do not need an anti-depressant, and since when did that become the drug of choice to treat a severe bacterial infection instead of an antibiotic? That sounds like malpractice to me. In the meantime I am still very sick and have nowhere to turn. Humana needs to be fired and replaced by an insurance company which will actually serve the needs of the military and their dependents. And people actually wonder why I do NOT recommend serving in the military to interested young people, it's because of things like this. Of course, Congress and the Senate will take care of themselves instead of fixing Tricare.
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Cons:
  • Online system does not work
Reason of review:
denied coverage
Paul A Hpk
map-marker Silver Spring, Maryland

Incompetent claims review

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I filled a claim in the amt of 18,628 in March 2018. I was informed by them that i could receive treatment from this out of network provider but would have to pay up front and submit the claim t ok them after the treatment was completed.

I understood i may not get reimbursed for the total amt but a percentage. Today, 10 months later and after over 30 calls and an inquiry from my Senator, Marco Rubio, they said that the billing code used by the treatment center was "a non government pay code" and there they would only cover some lab work in the amount of $10.53. They even brushed off Senator Rubio by saying that they would expedite the claim. They are beyond incompetent.

Each time i spoke to them they requested further information which i supplied immediately spending over $200 in ups fees to send the documentation. On several occasions they lost over 200 pages of my medical records which i sent to them again. Not once did they mention to me about billing codes.

Now Im stuck with filing a grievance and we all know how that will play out. They suck Angry

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Reason of review:
Order processing issue
2 comments
Guest

Quality of care is terrible with Tricare doctors....i have pretty much resigned myself to the fact that I am gonna die before they figure out what is wrong with me.

Guest

well this kind of falls on your fault for not making sure the care you was receiving was a covered service. You can never be too sure on this type of thing, and , yaknow, if it was me that was going to be accruing thousands of dollars of doctors fees, I would be making sure to cross my T's and Dot my I's.

Always call Tricare to check that the codes for the care you are receiving are covered services before even going to the first doctors visit. Plus if it was a Gov no pay code, that means its not just Tricare that wouldn't pay it, that means it is a government wide non payment, Which goes for Medicare, and Medicaid as well.

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Kevin J Qmo
map-marker Albuquerque, New Mexico

Tricare-Humana in Huntsville no longer accepted by Pediatrics

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In 2018, Tricare sent letters out to offer changes to the Primary Care Managers for children since the mileage to base exceeded 20 miles. After reviewing Tricare online, there were 3 civilian pediatric clinics listed on the Tricare website. We selected the closest one for our children. But now in early 2019, the pediatric clinic stopped seeing any military due to underpayments for treatment and tests. Called the other two and the other pediatric clinics also stopped seeing military with Tricare-Humana. Clearly Tricare is aware of this since their website now shows there are no pediatric providers within the Huntsville area. No letter nor emails from Humana informing that our pediatric provider has dropped Humana. The only way we "discovered" this was thru trial and error. Wow. On hold right now with Tricare-Humana; over 30 minute hold time. Still in the military for over 28 years and never experience the drop in Tricare since Humana became the military's medical insurance provider.
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Loss:
$120
Pros:
  • History of great service
Cons:
  • No consistanty with service
Reason of review:
Poor customer service

Preferred solution: Let the company propose a solution

Anonymous
map-marker Phoenix, Arizona

No availability on base

My wife was in a very serious car wreck, after staying in the ER she was told she needed to see a specialist for her back. (A fractured vertebrae). She contacted the nurse advice line as the base clinic was closed. They told her she has to be seen by her PCM to be referred to a specialist, but her PCM has no availability for the next SIX MONTHS. Its February, and there is nothing available until July. So we are having to pay thousands out of pocket to get her the care she needs. Tricare, specifically Tricare Prime. Is the most useless, frustrating, pathetic piece of garbage.
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Heather l Mnz
map-marker Elkridge, Maryland

Tricare humana is horrendous

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I agree my husband and i never had any issues with tricare until jan 2018 when they went with humana.

I spend many days on the phone with humana because they did not pay on bills correctly.

Not to mention they do not want to pay for very important medication for our daughter. The only medication that so far works for her . We are drowning in co- pays since they more than doubled and other bills that we never would have had tk pay so much towards.

Military veterans as well as the family members have endured years of effects from our loved ones giving their lives in combat and now we cannot even get the good medical care we once had. Its shameful and embarrassing.

They wonder why so many military are not getting the medical care they need because we cannot afford it. This is unacceptable.

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Reason of review:
Problems with payment
7 comments
Guest

Humana Tri Care East is horrible. They are unable to answer basic questions or critically think.

Guest

This is not true. Humana is responsible for processing claims.

I am a former medical claims adjuster. I have never seen such a mess! Customer service is poorly trained, deliberately drops calls, lies ( we have no supervisor anywhere!), and transfers whatever they can, often to mailboxes that are full. Claims department has supervisors that not only cannot understand the contracts they are attempt to explain to customers but time after time make the same errors only to apologize and apologize.

I have talked with 4 claims service reps, 3 claims Dept people, 1 supervisor and will be calling that supervisor’s manager and the VP of Claims in the home office in KY. You have power. Go to Tricare.mil and file a grievance for each and every issue you have with Humana.

Hopefully, as soon as Tricare can legally replace Humana, they will. I have never in all my years of adjusting seen such incompetent uncaring individuals.

Guest
reply icon Replying to comment of Guest-1588084

humana is not responsible for processing claims WPS is. Please Educate.

Guest
reply icon Replying to comment of Guest-1597851

Humana is the contracted provider for Tricare East. WPS is contracted through Humana to process Humana Military claims. So in reality, Humana IS responsible for the entire mess for not contracting a company that is capable of doing the job right....

Guest

Tricare Humana health care customer service isIt’s horrible federal health that service was great the customer service people knew what they were talking about with Umana I’ve been trying for four months now to get back claims paid when they keep saying man at tri-care is not my primary insurance and it’s my only install it this is ridiculous you call their customer service and knowledgeable they get smart with you it sucks

Machele Imf

Congress set this thing up and thus, you need to contact your congressional rep to complain. I know your frustration from talking to some affected by this travesty. But, the place to complain is to your congressman, hopefully he is not a democrat.

Guest
reply icon Replying to comment of Machele Imf

you think you're bright

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