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Insurance miscommunication leaves Tampa woman without home nursing access

Insurance miscommunication leaves Tampa woman without access to home nursing
Posted at 9:42 PM, Apr 29, 2022
and last updated 2022-04-29 23:51:50-04

TAMPA, Fla — Lyn Hunt said over the years she's needed to get her blood drawn a lot.

"I have a problem with my lungs. I also am a type 1 diabetic," she said. "I also have fibromyalgia."

But for the Hunt, traditional IV methods don't work.

"It feels like fire, it always burns," Hunt said. "The veins collapse and even the saline burns."

And after years of painful experiences about five years ago, she had a medical port implanted in her chest to make things easier.

Medical documents show since then she's been having a home health nurse come out to help manage the many medications she takes and flush out her port. Most recently, that care has come from AdventHealth Home Care West Florida.

"It has to be by a skilled nurse which my doctor wrote that on many letters," she said. "Someone who is not skilled cannot do a port and if you don't flush it every month it can get clogged or it can get an infection which could potentially kill me."

But late last year, Hunt says her monthly services were canceled and she wasn't sure why.

"I'm really not very happy, because how would they like to be in my shoes," she said.

She's appealed that decision twice, but her services weren't restored. So in January, she contacted ABC Action News.

After months of working with Hunt, ABC Action News found client notes from her last home health appointment in November. That document shows that her former nurse put in a call to her insurance provider, Humana, to request a case manager look into why she was being discharged from the program.

A note from one month later shows a representative from AdvenHealth called Humana again to explain that Hunt had ongoing needs for her port, that were no longer "covered by Humana."

Another note, dated two days later shows that Hunt's nurse encouraged her to appeal the decision to discharge her from the services.

She did, twice—once in December and again this month, with Kepro BFCC-QIO. The organization describes itself as the following:

Kepro is the Beneficiary and Family Centered Care Quality Improvement Organization for the 29 states. Kepro helps people who are on Medicare - and their families and caregivers - to file quality of care complaints and hospital discharge and skilled service termination appeals. We also offer Immediate Advocacy services to quickly resolve medical concerns.

Following her December appeal, Humana issued an "explanation of non-coverage," which says that skilled nursing services would be covered if they were needed to maintain a patient's current condition or keep them from getting worse. It also states Hunt has a "long-standing condition that no longer requires monitoring" and it goes on to say that her "port hasn't been used in years" and no longer needed to be flushed out.

But, Hunt said her port has been used and often.

"All it ever did was got flushed, and he drew my blood," she said.

More recently, in February, Hunt's doctors issued two notes calling for her to have her blood drawn via her port and for her port to be flushed monthly. Both listed "Home Health Care" as the means to get this done.

In March, Hunt's doctor issued another note saying "Home healthcare will be required indefinitely."

So far, Hunt's services still haven't been reinstated.

"I'll just tell you like this, I just feel like nobody really cares what happens to people anymore," she said.

Earlier this week, ABC Action News contacted AdventHealth for more information. They released the following statement:

We understand the process can be confusing to navigate, but the patient is not eligible for skilled services from AdventHealth Home Care West Florida at this time. AdventHealth does not have the authority to reinstitute services. We spoke with our home care team, and in order to reinstitute services, ms. Hunt will need to work directly with her physician and Humana case worker to receive a physician’s order to qualify for skilled case services.

The next day, ABC Action News contacted Humana, because Mrs. Hunt does have a doctor's note.

Humana released the following statement on Thursday:

Protecting our health plan members’ privacy is an important priority for Humana, and federal privacy regulations restrict what information we can share about individuals and their medical care. That said, we work diligently to resolve issues our members encounter in accessing the care they need. Humana is committed to providing our members with access to high-quality health care, which can include care delivered in their homes – for members who meet standards we follow that are set by the centers for medicare and Medicaid services.

Hunt said she's also gotten a call from Humana with a promise that they would look into this issue, but she still doesn't know where this leaves her.