do you have humana insurance?
All of our patients are very important to us and we keep our patients’ best interests in mind with every decision we make. In order to continue to provide the highest level of one-to-one care to our patients, we had to make the difficult decision to terminate our contract with Humana as of February 1, 2025. The Humana plans that will be affected include:
- Humana Gold Plus (HMO)
- HumanaChoice (PPO)
- Humana Value Plus (HMO)
- Humana Gold Plus (HMO)
- HumanaChoice (PPO)
- Humana USAA Honor (PPO)
- Humana Gold Plus SNP-DE (HMO D-SNP)
- Humana Walmart Value Rx Plan (PDP)
- Humana Basic Rx Plan (PDP)
- Humana Premier Rx Plan (PDP)
As of October 21, 2024, MTI Physical Therapy (MTI) will no longer be accepting new patients who are Humana members.
For existing Humana patients, we will no longer be able to submit claims for in-network coverage after January 31, 2025. We hope that you will be able to complete your Plan of Care and achieve your goals before that time.
If you are an existing patient who wishes to continue care after January 31, 2025, you will be converted to a “fee for service” payment system and then have the option of personally seeking reimbursement from Humana if you have “out of network” benefits.
WHAT IF I HAVE A HUMANA SUPPLEMENT OR SECONDARY INSURANCE?
While we will be out-of-network with Humana as of February 1, 2025, Insurance billing is very complicated and there are some nuances that need to be kept in mind if you have a secondary or supplement insurance plan. These two types of plans are different:
- A SUPPLEMENT plan is a gap plan, it exists to pay some or all of what Medicare assigns to “patient responsibility”. It generally does not pay the deductible.
- A SECONDARY plan is a second health insurance, usually a commercial insurance plan (sometimes Medicare or Medicare replacement), that usually pays for some or all of what a Primary insurance plan does not pay (copay, co-insurance, deductible). This is also called a coordination of benefits.
We are bound by Medicare Regulations, which do not allow for a patient with Medicare or a Medicare Advantage Plan (i.e. Humana Gold, Humana Gold Plus, etc) to be Self Pay. As such, if you are enrolled in Medicare AND have a Humana plan, or you are enrolled in a Humana Medicare Advantage Plan, we may still be able to bill for your visit.
Please see the table at the bottom of this page, which outlines the nuances with secondary / supplement insurances to help clarify things.
WHY IS THIS CHANGE HAPPENING?
MTI has always strived to provide the highest quality of care to our patients. We believe that one-to-one treatment with a highly trained Physical Therapist is part of that recipe for the high standard of care we are known to provide. Insurance companies such as Humana make it difficult for us to continue providing the quality of care we believe our patients deserve. In order to accept Humana, we would be forced to double book patients, spend less time with our patients, or even consider using support staff. This is not a direction we are willing to go, as we do not believe that it is in our patient’s best interests.
We truly love working with our patients who are Humana members, so this was not an easy decision to make.
WHAT HAPPENS NOW?
Nothing will change for our existing patient right now. Existing patients should have ample time to complete their treatment and reach their goals, since our Humana contract will not lapse until February 1, 2025.
WHAT DOES “OUT OF NETWORK” MEAN?
Providers who are “out-of-network” are those who do not participate in that health plan’s network. After our Humana contract ends on January 31, 2025, MTI will not be in-network with Humana. This means that MTI will no longer be able to submit claims on behalf of our Humana patients.
WHAT DOES “FEE FOR SERVICE” MEAN?
Existing patients who wish to continue care after January 31, 2025, will be converted to a “fee for service” payment system. “Fee for service” means that you pay a flat rate at the beginning of your appointment. Our rate is $200 for an initial evaluation and $135 for each follow up visit. If you have “out-of-network” benefits, you can personally seek reimbursement from Humana after your visit.
Use the grid below to determine whether or not we are able to accept your plan after February 1, 2025:
| Primary Insurance | Secondary / Supplement | Do we accept these plans? | Payment Information |
| Medicare Primary | Humana (non-Medicare) Secondary | Yes | We are happy to be able to continue to provide you with care at MTI. We will take care of billing both your Medicare Primary and your Humana Secondary. Please review your Humana Explanation of Benefits (EOB) when it arrives to determine what your patient responsibility will be for your visit. Please contact your insurance provider for more information. |
| Medicare Primary | Humana Medi-Gap Supplement Secondary | Yes | We are happy to be able to continue to provide you with care at MTI. Because you are a Medicare patient, we will bill your Medicare plan for your visit and then any remaining balances will be billed to your Humana supplement plan. Please review your Humana Explanation of Benefits (EOB) when it arrives to determine what your patient responsibility will be for your visit (if any.) Please contact your insurance provider for more information. |
| Humana (non-Medicare) Primary | Any Secondary Insurance (Medicare or other Insurance) | Yes | We are happy to be able to continue to provide you with care at MTI. We will take care of billing both your Humana primary insurance and your secondary insurance for your visit. However, because we are out of network with Humana, they may deny the claim. Your secondary insurance may cover some of your visit. You will receive an Explanation of Benefits (EOB) from your secondary insurance, which will outline your patient responsibility (the amount you will owe for your visit.) Please contact your insurance provider for more information. |
| Humana Medicare Plan Primary (with no out-of-network benefits) | Other Insurance (non-Medicare) Secondary | No | We are not currently in-network with your primary insurance plan, and based on the Medicare billing rules, we cannot bill your secondary plan. So at this time, we cannot see you as a patient. You may be wondering if we can see you on a self-pay basis. Unfortunately, since you are contracted with a Medicare plan, we are not allowed to collect any money directly from you for your visit. Please contact your insurance provider if you have additional questions. |
| Humana Medicare Plan Primary (with out-of-network Benefits) | Other Insurance (non-Medicare) Secondary | Yes | We are happy to be able to continue to provide you with care at MTI. If you have out-of-network benefits with Humana Medicare, we can bill your primary insurance. Any remaining amount will be billed to your secondary insurance. Whatever is left over will be your responsibility – please view your Secondary Insurance’s Explanation of Benefits (EOB) where your responsibility is outlined. Please note that since we are out-of-network with your primary, you may face higher cost share amounts than you would with an in-network provider. Medicare Advantage plans that offer out-of-network benefits are allowed to leave additional patient share amounts and certain secondary plans may not cover all or any of this amount due to the primary plan network not being utilized. Please contact your insurance providers if you have additional questions. |
| Humana Medicare Plan Primary | Non Contracted Secondary (UHC, Humana, Medicaid) | No | We are not currently in-network with either of your insurance plans, so unfortunately, we cannot see you as a patient. You may be wondering if we can see you on a self-pay basis. Unfortunately, since you are contracted with a Medicare plan, we are not allowed to collect any money directly from you for your visit. Please contact your insurance providers if you have additional questions. |
| Humana Medicare Plans (i.e. Gold) Primary | NA | No | We are not currently in-network with your insurance plan, so unfortunately, we cannot see you as a patient. You may be wondering if we can see you on a self-pay basis. Unfortunately, since you are contracted with a Medicare plan, we are not allowed to collect any money directly from you for your visit. Please contact your insurance providers if you have additional questions. |
| Humana (non-Medicare) Plan Primary | NA | Yes | We are happy to be able to continue to provide you with care at MTI. Because we are no longer in contract with Humana, we can not bill your insurance for your visit. However, we would love to continue to treat you on a self-pay basis, meaning you pay for services at the time of your appointment at our self-pay rate. If you have out of network benefits with your insurance, we can provide you with a Superbill that you can submit directly to your insurance provider. They may reimburse you for your visit at your out-of-network rate. |
QUESTIONS?
We are happy to answer any questions you may have about this change. Please contact our Billing Department at (425) 650-2708.