InsuranceComplaintCheck

Humana — Insurance Complaint Report

Humana Faces Above Average Complaints, Primarily Related to Prior Authorization and Claim Denials

Key Metrics

AI Insurer Analysis

Humana has accumulated 462 insurance complaints on record. Their NAIC complaint ratio of 1.15 is above average, meaning they receive more complaints than expected for an insurer of their market size. With approximately 3.5% market share, Humana is a mid-sized player in the insurance market. The most common complaint categories are: health (20). Humana exhibits an above-average complaint ratio, suggesting potential areas for improvement in customer service or policy clarity. The majority of complaints are concentrated in 'Prior authorization' and 'Claim denial' categories, indicating recurring issues with these processes. While specific state data is limited, the distribution across several states suggests a widespread, rather than localized, issue. The recent complaint count of 20 within the observed date range highlights an ongoing volume of customer dissatisfaction. Humana's complaint trends indicate a persistent issue with administrative processes, particularly prior authorization and claim adjudication, leading to an above-average complaint ratio. Areas of concern include: Above-average complaint ratio indicates systemic issues.; High concentration of complaints in 'Prior authorization' and 'Claim denial' requires immediate attention.. On the positive side: No reported regulatory actions suggest no major legal or compliance breaches.; The insurer offers health coverage, a critical service for many consumers..

Risk Breakdown

Red Flags

Green Flags

Consumer Tips

When dealing with Humana, keep these practical tips in mind: 1. Before seeking care, understand Humana's prior authorization requirements for procedures and medications. 2. Keep detailed records of all claims submitted and communications with Humana regarding claim denials. 3. Review your policy documents carefully to understand coverage limitations and billing procedures. Before purchasing a policy, compare Humana's complaint ratio (1.15, above average) with competitors offering similar coverage. Always read the full policy document, paying attention to exclusions and limitations. Document all communications with the insurer in writing. If you experience a dispute, file a complaint with your state Department of Insurance — it is free and often results in faster resolution.

Trend Analysis

Humana's complaint trends indicate a persistent issue with administrative processes, particularly prior authorization and claim adjudication, leading to an above-average complaint ratio.

Frequently Asked Questions about Humana

Is Humana a good insurance company?

Humana has 462 complaints on record. Their NAIC complaint ratio is 1.15, which is above average. They hold approximately 3.5% market share. A complaint ratio below 1.00 indicates fewer complaints than expected for a company of this size; above 1.00 indicates more.

What are the most common complaints about Humana?

The most common complaint categories for Humana are: health (20). The leading specific issues are: Prior authorization (5), Claim denial (3), Network dispute (3).

How does Humana compare to competitors?

Humana's NAIC complaint ratio of 1.15 is above average. Companies with ratios below 1.00 receive fewer complaints relative to their size. When comparing insurers, also consider financial strength ratings, coverage options, and premium pricing alongside complaint data.

Should I file a DOI complaint against Humana?

If you have an unresolved dispute with Humana, filing a complaint with your state Department of Insurance (DOI) is a free and effective option. Steps: (1) Gather all documentation including your policy, correspondence, and claim records. (2) Contact your state DOI — most Humana complaints come from Minnesota. (3) File online or by mail. (4) The DOI typically responds within 30-45 days.

Are Humana complaints getting better or worse?

Humana has 462 total complaints. In the most recent data, 20 complaints were recorded across 1 coverage categories. Check the NAIC Consumer Information Source for the most current complaint ratio trends.

What insurance companies have the lowest complaint ratios?

Insurance companies with the lowest complaint ratios typically include mutual insurers and member-owned companies. To find alternatives to Humana, compare NAIC complaint ratios for companies offering the same coverage types (health, etc.). Your state DOI website provides complaint data specific to companies licensed in your state.

Has Humana been fined or sanctioned by insurance regulators?

Regulatory action information is available through your state Department of Insurance and the NAIC. Humana has 462 consumer complaints on record with a complaint ratio of 1.15. For specific regulatory actions, check the NAIC Regulatory Actions database and your state DOI enforcement records.

Which states have the most complaints against Humana?

The states with the most complaints against Humana are: Minnesota (2), Maine (2), Wisconsin (2), Rhode Island (2), New Hampshire (1). This distribution may reflect the company's market presence in those states rather than indicating worse service in specific locations.

What patterns emerge from Humana's complaint data?

The complaint data spans a very recent period, suggesting the issues are current.

How does Humana handle claims compared to peers?

The 'Prior authorization' sub-type is the most frequent complaint, pointing to a significant bottleneck.

What is the complaint trend for Humana?

Humana's complaint trends indicate a persistent issue with administrative processes, particularly prior authorization and claim adjudication, leading to an above-average complaint ratio.

What should prospective policyholders know about Humana?

Despite a market share of 3.5%, the complaint ratio is notably above average.

Are there systemic issues in Humana's complaint history?

The limited number of complaints by state might be due to the reporting period or market penetration in those specific states.

Recent Complaints Against Humana

Humana Complaints by State

Humana Complaints by Coverage Type

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This analysis is based on NAIC complaint data and AI interpretation. Not legal, financial, or insurance advice.