Updated: 10/19/2013 9:29 AM
Created: 10/18/2013 8:07 PM KSTP.com
By: Stephen Tellier
The Minnesota Attorney General is asking the federal government to investigate one of the state's largest health insurance providers, accusing Humana of a pattern of denying claims and overcharging folks on Medicare.
The Attorney General's office compiled several hundred pages of affidavits that it presented to the federal government on Friday. The office said it proves Humana has been improperly handling insurance claims by dozens of Minnesotans enrolled in its Medicare Advantage plans.
It's the diagnosis every woman dreads.
"Really scary. I still cry every time it's mentioned," said Darlene Tucker, a 75-year-old breast cancer survivor.
Two years ago, Tucker learned she had breast cancer. Already enrolled in one of Humana's Medicare Advantage plans, and on a fixed income, her agent helped her prepare for treatment.
"He changed my policy to a little bit more expensive to make sure I would have no co-pays," Tucker said.
It wasn't until after 31 grueling sessions of chemotherapy that a bill arrived.
"That I owed $994 and so much cents, and I said, 'This is crazy,'" Tucker said.
She had been charged co-pays for every visit.
Then, for six months, it was back and forth between patient, provider and insurer.
"I think the worst part was when they turned it in to a collection agency," Tucker said. "It's just like, leave me alone, is kind of what I wanted them to do."
Tucker's case is one of more than two dozen Minnesota Attorney General Lori Swanson is taking to the federal government.
"It's very egregious," Swanson said.
Swanson said Humana has repeatedly denied legitimate claims, overcharged for co-payments, and failed to disclose which providers are in network.
"Here, we had seniors who were just beating down the doors of Humana saying, 'Look, you didn't cover a claim that was plainly covered,'" Swanson said.
She said it's costing Minnesotans thousands.
"Seniors are ending up with a lot of out-of-pocket costs that they didn't bargain for and that aren't fair," Swanson said.
Tucker dropped Humana after her provider finally dropped her bill.
"I didn't want anything to do with them. I was so upset," Tucker said.
She hopes the federal government will do something.
"If it helps anyone else, that it wouldn't happen again," Tucker said.
Humana provided Five Eyewitness News with the following statement: "Humana has not been notified of this matter by the Minnesota Attorney General's Office or by CMS. We take this very seriously and are working to identify the facts. We have been successfully serving the people of Minnesota for more than 10 years and more than 100,000 Minnesotans belong to Humana plans. Our Minnesota Medicare Advantage plans have achieved one of the highest CMS ratings for performance and service, with a rating of 4.5 Stars on a five-star scale."
Swanson said she's not advising Minnesotans to stop enrolling in Humana plans. She's simply urging all Minnesotans to do their homework and get everything in writing. And if you can't resolve an issue on your own, contact the Attorney General's office.
The Attorney General's office is unable to take legal action against Humana on its own because the federal government is the only entity allowed to enforce the rules of Medicare. So the most serious action the State of Minnesota can take is to ask the federal government to investigate.