Part one. We had a bad year of things in 2025, becoming two-fold disaster victims with Hurricane Helene and Milton, in September and October 2024 staying in a FEMA funded motel that had bed bugs. Fighting off the City Inspector, who called code enforcement and APS on us, as a bullying tactic, so as to strong-arm us into selling our property to investors that swooped in like vultures, offering us an insulting $150K, so that we can be replaced with luxury Airbnb. I guess we looked like an easy mark as a collective of a mix of vulnerable elderly, severely physically disabled and medically fragile 100% autistic household, with only one of us not dependent on a wheelchair or a walker. Two are part of the Lost Generation of Autism, where Judith age 85, and Georgia 79, didn’t get their autism diagnose until very late in life. Desi got her HFA (high functioning autism) diagnosis, in 1977, at age 9, and Nikki was only 18 months old. We make up the newly launched Autistic Dimensions Florida. A remnant of Autistic Dimensions Hawaii, that while we still had thrived in the rural remote off grid community in Hawaii, we struggled with the volcanic eruptions starting from 2018, with the subsequent VOG (volcanic ash fog) that had us evacuate again due to breathing issues, and the increased weather issues, that culminated with the Maui Fires of 8/8/2023, that was the final nail on that coffin for our beloved Autistic Dimensions Hawaii community. 

We came back home to Florida in early 2024, barely recovering from the tragedy of The Maui Fires, flame 🔥 red skies, with smoke filling the skies like heavy grey black clouds, almost like the VOG, but worse,  the local fishermen hauling in bodies that had washed up ashore. We began to feel safer here back in civilization, although Florida is no stranger to devastating storms, Florida’s emergency response is quick, and thorough and their bounce back game is stronger. We have been bouncing back and forth from Hawaii and Florida, until we finally made the decision to permanently settle back in Florida, just in time for the hurricanes of 2024. 

Surviving Helene and Milton was the easy part. Pinellas County Special Needs program not only called us, but checked in on us often ensuring we were going somewhere safe, as they were all set to evacuate us all to a special needs shelter. It was afterwards where our year long struggle staving off homelessness, and the three medically fragile autistic household members of the newly named Autistic Dimensions Florida, faced an uncertain future, staving off homelessness, or 75% of Autistic Dimensions Florida, ending up in nursing homes. We refused to let things break us, or to give in to the easy solution of the three vulnerable members just go to “where they belong” into Medicaid funded nursing homes, due to complexities of their medical conditions, which included seizures and heart conditions, physical disabilities with only one pair of hands to push three wheelchairs en tow. 

But we made it somehow. Even with that awful scare when 85 year old Judith needing to be rescued from a nursing home facility. She was rushed out of there with cardiac distress and a 103 fever, after her screams for help were ignored for two hours.

So much for that option. 

Thus, LTC (Long Term Care) and APD (Agency for People with Disabilities) care was approved for the three medically fragile, under the crisis option. Nikki was accepted under APD, while Georgia and Judith were both approved for LTC care. Georgia however was put on the LTC waitlist. 

We finished off the year with Humana LTC coming in new to the scene, as the option ti prevent Judith ending up in nursing home, but as the icing on the cake of our year long struggle, by Humana LTC instead just getting their kicks in,  and finishing off our year of living in uncertainty, daily survival mode, and a life of scarcity and poverty. But regardless  of all the lack, we have learned to live with, and surviving being disaster victims, as the most vulnerable population, where medical issues made trips to the ER, and hospital admissions routine throughout 2025, we still managed to at least still together. 

Instead of being the solution to prevent Judith from ending up in a nursing home facility again, the red tape, and struggle getting just the basics in without it being a struggle of having every single benefit, big or small, be another jumping through hoops venture, we had to go through for everything, whether it be from diapers, meals, to adequate care hours, and back pay. It took 3 months and firing the first care coach just to get the diaper size corrected. Only to have the diapers reduced in a Notice of Adverse Determination Notice letter stating that Judith didn’t meet Humana’s criteria, while Judith actually meets EVERY criteria Humana listed. 

The last portion listed on the Humana letter, reflects a clear retaliatory reason for the reduction as the Humana letter stated under Other Authority that the size change made by us, the client, directly resulted in the diaper reduction from 98 to 90 diapers. 

Our size change was from the size XL, which came with 14 diapers per package, to the size L, that came with 18 diapers per package. Which  would have INCREASED the amount of diapers per month, from 98 to 126, not decreased them. 

The only reason the diapers were decreased from 99, to 90, was because Humana decreased the packages from 7 packages a month to only 5 in December. 

We saw this reduction in diapers as clearly retaliation in part of the last care coach that was one ☝️ of the many issues we’ve had with Jackie, and the last thing she worked on in Judith’s case before being oust. Clearly a retaliatory move on her part, as she attempted to also change the medical supply company, First Quality, who disclosed how they themselves, also, had also been trying to contact Jackie the cc, for the to correct the diaper size, for the past month, since Jackie failed to resolve the diaper size change before November, as she stated she would do.

As well, as the clear retaliation of Humana’s case manager, Tania H., Jackie’s supervisor, in hosing Autistic Dimensions caregiver Desi on the start date as Judith’s caregiver, that we were made aware of from multiple sources that all Tania H. had to do was approve the start date of November, the time frame when Desi was already put through with the GT caregiver contractor start time which was November 2025, only awaiting the fingerprints results, that was cleared on December 3rd, and sent and received by Tania H on same date. 

However, Tania H. had refused to do so even as it was verified TWICE that Tania H., had received the results of everyone’s prints on December 3rd, 2025. Humana’s Tania H. however sat on the results, and we didn’t even fire Jackie until December 8th, 2025. Tania H., who had everything to get us going from the beginning of the month of December, which would have been in time to ensure Desi would be able to receive her first paycheck before Christmas, instead didn’t put in the start date until the Sunday before Christmas, ensuring that there would not be a paycheck until January, AFTER both Christmas and New Year!! 

This was also clear retaliation for us refusing to remain with Jackie, who caused all kinds of the delays with EVERY other service, from diapers to meals, to sabotaging that in her last move by attempting to change the brand of the diapers and the medical supply company, without our acknowledgment nor our consent. 

But that was also a retaliatory effort, for the medical supply company verifying that they had also been trying to contact Jackie to correct the size, for the entire month of November, but to no avail. Fine. So go ahead and change to medical supply company for that move. Now, not only was that clearly retaliatory, but also very petty.

The brand name change was put in by Jackie, as being requested by us, noted by the Humana call center, as we, the clients, only wanting only the Mcklennen brand, which we were unfamiliar with, and First Quality medical supply didn’t carry. 

We were happy with the Tena brand, and First Quality medical supply. We only needed the size L, not the size XL, for over 3 months that was a mission, because neither First Quality, nor us, the clients, could change the size ourselves. So what was all this about with changing brands, and medical supply companies all about? It was stunts like this that was just TOO tiring to have to go through, with everything else we all have to deal with. That of course, we felt had ample reasons to call Humana to change care coach in December 8th. Which we had our request for the change met with great resistance, as our issues were trivialized and dismissed, as Tania H., attempted to ignore our request for a care coach change, as it would inconvenience her to do so. 

Right. We have been inconvenienced enough with EVERY service with Humana LTC that Jackie took on, and caused. Like the meals we had first ordered with Jackie back on October 8th, that we never received the denial for, because we finally found out in December, that it was due to meals that had in fact been voided out by Jacki, under her claim that we had insufficient freezer space. She never even discussed that action on her part with us. As we have three refrigerators, including a full size one parked on our front porch. 

So when the diapers finally came in, Judith stated that it will either be the wrong size, AGAIN, or something else would be wrong with the order, and offered to bet on that. She had no takers. 

I responded when we opened the diaper order, that instead of receiving four wipes, only two wipes came in. And instead of 7 packages of diapers, only 5 packages had came in. 

Judith: “But of course. This is how we are punished for complaining. It’s our right to do so but it will always come with a price. We complain, and all of a sudden we get less diapers. Always something bad happens. The second part of the letter is important, as that put into the letter there clearly shows that it is from either Jackie, who we already know always does things like this, or Tania H., herself for; how dare we exercise our rights, and demand that our care coach be replaced? I told you, this is how we are punished. There is ALWAYS a price to pay to making a complaint. It’s why so many elderly and disabled clients  are SO afraid to complain. Because these are things they desperately need, and making complaints, can result in they suffering some kind of punishment for them doing so. Which we clearly are now seeing what punishment now got, for us causing them “trouble”.

Desi: “Now it can potentially take up to 90 days for the Appeals process, and that’s a great eff you, for us complaining..”

Judith: “We’re supposed to be able to complain without getting retaliation for it. But here we are, suffering said retaliation for it. I told you so. Bullies and liars. Document it and put it on the spiders web.”

Desi: ”You mean World Wide Web?"

Judith: ”The Spider’s Web. She puts the word out there. Make ‘em famous for it. Put the word out there on the street.”

Desi: “Actually, the World Wide Web by passes the limitations of “word put out on the street.”

Judith: “Your autism is showing. You figure out what I meant. The new “word on the street. Give it to the spider.”

Desi: “There is no spider on the World Wide Web.”

Judith: “So how is the World Wide Web made without a spider?”

Georgia: “Both of your autism is showing. And doesn’t matter. We may be old and autistic but we’re not stupid. We now ALL know that all Tania H. had to do was approve the start date for November, but again, Tania H., clearly is punishing us, by instead putting in the start date for the Sunday before Christmas, for again, for exercising our rights, and inconveniencing her. As we were all made aware of her tone, we all recognized as smugness, of being the one in control of things, and not liking us insisting on exercising our rights, while she and the other one Nathalie pushing us to remain with Jackie. This effects us all. I’m on the LTC waitlist myself. We cave in to bullies now, and they will continue on with this when it’s my turn. I will fall under the same case managers eventually. So it may take time but whatever we don’t fight now, we will end having to fight later. That girl made me nervous calling us up again and again for my social security number that she said kept accidentally erasing. I wondered how many credit card applications she was running. After someone enrolled me into ACA’s Healthy Marketplace, this past year, without my knowledge and consent, that got me nervous.”

Desi: “Oh, yeah, that was all the call logs that Tania mentioned seeing. But as Jackie been lying to us on so much, from meals to diapers, that we couldn’t trust her on anything else. Why wouldn’t she also lie to her supervisor?”

Judith: “Doesn’t matter if we right to be upset and to complain. Or all the good reasons we have to complain. Humana, and most case workers, all of them, loves us old and disabled being too stupid, too dependent on them whatever bs they tell us as being correct. They hold the services we need. And they can and will hold them against us. And when they lie to us, whenever they please? Give us the run-around? What can we really do about it when they do? Jackie lied. And Tania knew it. She just  tried to cover for her. But they love the ones too stupid to complain. And the ones who know their rights, and exercise them? We get labeled as “difficult” and you see? this is just our punishment for it. Don’t matter what they put in their handbook, that we supposed to have the right to complain without being punished for it. But here we are. Being punished for it. If there is a web, there’s gotta be a spider. Give it to the spider. Tania may have succeeded in ruining Christmas for us, but may the spider and Saint Michael, bring her actions back to her.”

Georgia: “Yes, on Saint Michael to come in for us. Yes, it's all an inconvenience on us, right now, the games they playing on us. But we dealt with greater bullies. And we still here. Yes. It is indeed a type of bullying, clear as day, being played on us. This kind of obvious punishment that Tania is acting out upon us. And yes, because they are not used to old disabled people standing up for themselves. I'm Greek and we aren't a weak people. But they like us weak and helpless and accepting whatever scraps or indignities they toss our way. I refuse to play their victims. Regardless of they playing games with us right now with Judith’s services, her diaper supplies, and all the rest of it. Obvious punishment. Bullies again. We didn't run from City Inspector Keith M. We ain't running now. Cmon now! We made a fuss over the diapers, and they get reduced immediately after. It’s how they showing us that exercising our rights to complain will be followed by punishment for it. Humana must be exposed for their actions. These case workers and manager represents Humana. Humana is responsible for their case managers tactics.”

Judith: “This is why elderly disabled are so afraid to complain. Because of the retaliation that isn’t supposed to happen, but does anyway.”

Desi: “Good. We're all on board then. The website been taken care of for us. Now we just needa fill it up with everything we've been going through for over a year now, including the new Humana LTC issues."

Humana is currently facing significant scrutiny, including a class-action lawsuit and a U.S. Senate investigation, for its high rate of long-term care (LTC) and post-acute care denials in Medicare Advantage plans. These issues primarily stem from the alleged use of an artificial intelligence (AI) algorithm to override physician recommendations and systematically deny claims. 

Key Issues in Denials

AI-Driven Denials: A central issue is the alleged use of an AI model called "nH Predict" to determine how long a patient needs rehabilitative care. The lawsuit claims this algorithm makes "rigid and unrealistic predictions for recovery" and that Humana applies these predictions instead of individualized clinician assessments. 

High Denial Rates: A Senate report found that Humana's denial rate for post-acute care services in 2022 was more than 16 times higher than its overall denial rate for other services. 

Challenging Appeals Process: The lawsuit alleges that Humana makes the appeals process difficult, with only a tiny fraction of policyholders (around 0.2%) appealing denials, which the insurer uses to its advantage. When appeals are filed, the process is allegedly caught in a repetitive cycle of denial and review, causing harm to patients needing care. 

Impact on Patients: Patients have reported being forced to end care prematurely, forgo treatment, or deplete their personal savings to afford necessary long-term care after their claims were denied. 

Lack of Transparency: Patients and providers often reported they were not given the specific reasons or rationale behind the nH Predict decisions, making it difficult to mount an effective appeal. 

Recourse for Denied Claims

If a claim is denied, members have options to appeal the decision. 

1. Understand the Denial Reason: The denial notice should explain why the claim was rejected. 

2. Gather Documentation: Collect all relevant medical records, physician recommendations (especially those detailing the necessity of care), and any other supporting documentation. A personalized report from a treating physician can be particularly helpful. 

3. File an Appeal: You can submit an appeal in writing, by phone, or through Humana's online portal. Non-participating providers generally have 65 calendar days from the date of the denial to submit a written request. 

5. Seek Legal Counsel: Given the systemic issues, individuals may want to consult an attorney specializing in long-term disability or Medicare Advantage claims to understand their rights and options, including potentially joining the existing class-action lawsuit. 

6. Contact State or Federal Regulators: You can also report issues to the Centers for Medicare & Medicaid Services (CMS) or your state's insurance department.   

www.southernlegal.org 

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