Expert: Sara Scherer - 4/15/2007

Question
Hi - My mother enrolled in Humana Gold Medicare in January 2006.  They covered her health care costs throughout the year.  Then in December [2006] she had two cataract surgeries.  After the surgeries, she received a phone call from her doctor saying that Humana was refusing to pay.  When she called Humana they said that she wasn't enrolled and hadn't been - that her number had enrolled and disenrolled the same day (I guess 1/1/06).  They basically said "since you aren't enrolled, we can't talk to you - but we could enroll you and then we could talk to you".  She finally was able to "enroll" and Medicare proper covered her cataract surgeries.  But now, Humana is asking all of the other doctors who treated her in 2006 to reimburse them.  Where do we go from here?  Humana, Medicare, a lawyer, a consumer advocacy group?  [I haven't called Humana yet - I helped her with another piece a few months ago and we thought it was resolved, such as it were].  Thank you for any advice.

Answer
Call your State Insurance Commissioner and ask them to intervene.  They have been paying her bills so at some point they had her enrolled.  I would also look for any payments she may have made to them as premiums as proof that she was enrolled with them.

I think this is pretty low on their part.  The SIC should be listed in your Government pages.

Sara