Guest guest Posted May 13, 2010 Report Share Posted May 13, 2010 Recent issue has been with the meds. They absolutely will not authorize Straterra although the alternatives "they" will authorize aggravate tics. They also did not want to approve a referral for a liver scan but the physician was able to successfully appeal based on repeated blood work showing abnormal liver enzymes. Just to note: my own extremely expensive private insurance (not an HMO) gives me just as much resistance, if not moreso. I have problems from time to time with prescriptions (even at the $85 copay level) and refusals to authorize MRIs ordered by specialists. I'd like to know if any Humana HMO families are having issues with Humana. Please email me () party.of.4@.... Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2010 Report Share Posted May 16, 2010 Just an FYI, as far as referrals go, HMO authorizations begin and end with the PCP. They can authorize just about anything except for hospitalizations and medication formularies. Most medications can be authorized with a prior authorization form-that can be found on their website. Usual primary denials stem from not enough medical information being provided, or medical necessity being established. There is also an appeal process that I have seen personally go over the heads of the PCP management and get authorized by the powers that be at Humana. > > I'd like to know if any Humana HMO families are having issues with Humana. Please email me () party.of.4@... Thanks! > Quote Link to comment Share on other sites More sharing options...
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