The Kentucky Medical Association and Greater Louisville Medical Society contacted members in Jefferson, Oldham, Bullitt and Spencer Counties by letter, email, and blast fax to make them aware of an initiative being implemented through Humana for Ford UAW hourly employees in the Louisville area. As of July 1, 2008, all individuals covered under the Ford UAW hourly employee’s health plan – approximately 24,000 people – will be part of the Humana Preferred POS-Open Access Plan.
The plan is designed so that physicians who fail to meet certain economic criteria will be considered out-of-network, even if the physicians participate in other Humana networks. As a result of applying this method, it is our understanding that 25% of Humana-contracted primary care physicians and 50% of Humana-contracted specialty physicians are excluded from the plan. Furthermore, Ford employees enrolled in the Humana Preferred POS-Open Access Plan have NO out-of-network benefits. To determine whether you will be included, visit the Humana website at www.humana.com and select Humana Preferred POS-Open Access under the network selection.
Important Update on the Humana Preferred Product
The Humana Preferred Products are the Humana Preferred PPO and Humana Preferred POS-Open Access. The following physician/group types/specialties are evaluated for both the Humana Preferred Products:
Four primary care specialties reviewed:
Family Practice, OB/GYN, Internal Medicine, and Pediatrics.
Fourteen other specialties reviewed:
Cardiology, Gastroenterology, General Surgery, Oncology, Urology, Ophthalmology, Neurology, Pulmonary Medicine, Orthopedic, Dermatology, Otolaryngology, Allergy, Cardiovascular/Thoracic, Orthopedic Surgery, Chiropractors, and Podiatrists.
Specialties not listed above are considered participating for both the Humana Preferred Products.
To determine whether you will be included, visit the Humana website at www.humana.com and select Humana Preferred POS-Open Access under the network selection.
Step-by-Step Instructions
Go to www.humana.com
Click on Members
Under Provider search, click on Physician/Specialist
Enter zip code (i.e.40299)
Select network HumanaPreferred POS-OpenAccess
Agree to Terms of Use
Select County
Select Provider Type
Select Specialty or Search by Name/Group
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If you discover you are a participating physician with this plan, please be aware that the plan provides patients with information about their physician on the Humana website. The information provided on the website tells patients how the physician performs at following particular treatment guidelines and compares a physician’s data with other physicians. We encourage you to view the information contained on the Humana website about your own practice patterns so you know what your patients will see. We also encourage you to verify the data.
If you are not a participating physician in the plan, you may contact Humana Customer Service at 1-800-4-HUMANA to request an Appeal of Status. Likewise, if you are currently treating a patient being moved to this plan, the patient may request a waiver through Humana Customer Service.
Physicians should instruct their office staff to verify if patients have moved to the Humana Preferred POS-Open Access Plan. The easiest way to reduce confusion may be to simply ask patients if they are covered under a Ford hourly employee health plan.
KMA and AMA have produced a number of practice management tools that address physician profiling, including:
- Tiered and Narrow Networks: How to Challenge your Profile or Placement
- Physician Profiling: How to Prepare your Practice: Flyer explaining issues surrounding this trend.
- Pay for Performance Poster: Poster designed to educate patients about economic credentialing.
Click here to access these practice management tools.
As the Humana Preferred POS-Open Access Plan is implemented, please let us know of issues you encounter so we can continue to effectively advocate on your behalf. Call the GLMS Practice Advocacy Hotline at 502-736-6350 during business hours if you have any specific concerns beyond those addressed by Humana Customer Service. |
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