Humana Guidance

Humana’s Company Profile

Humana’s diverse lines of business position us to serve many types of consumers, including seniors, military members, and self-employed individuals. Find out how Humana’s associates and corporate leaders are dedicated to delivering new innovations to better serve our customers. Also view recognitions that reflect Humana’s commitment to our consumer.

Diverse Products & Services

Humana offers a range of products and services in addition to group health insurance. Our lines of business serve the military, individuals, seniors, and many others. We also offer specialty products, and other innovative consumer initiative products, services, and partnerships that are focused on consumers.

Compare Your Healthcare Choices

As a Humana member, you’re entitled to information that can help you make confident healthcare decisions and reduce your out-of pocket expenses.

Our role is to provide you with information about your healthcare choices – not to make those decisions for you.

Humana’s Medicare Advantage Plans

Different Medicare Advantage plans for different needs

Humana offers several Medicare Advantage plan choices. Not sure which plan is best for you? Just think about what you want and need most from your coverage.

Humana Gold Choice (PFFS)

Is flexibility most important to you? Humana Gold Choice (PFFS) plans may deliver flexible coverage that’s still affordable.

Humana Gold Plus (HMO)

Need to stretch your healthcare dollar? Humana Gold Plus (HMO) plans offer broad coverage with affordable, fixed costs.

HumanaChoice(PPO)

Want to balance choices with your bottom line? HumanaChoice(PPO) plans can give you freedom to choose and ways to save.

Medicare Supplement Insurance Plans

A Guide to Humana’s Medicare Supplement Insurance Plans

Humana’s Medicare Supplement insurance plans help cover some of the costs not covered by Medicare Parts A and B, such as deductibles and coinsurance, so you have more predictable costs. You can keep the same doctors, you are still in the Medicare program, and you have all of your Medicare rights and protections. It should be noted that Medicare Supplement insurance plans are not managed care.

Personal Nurse

What Does A Personal Nurse Do?

Although Personal Nurse is a phone-based service, it’s different from a nurse-on-call hotline. Participants work one-on-one with a nurse who takes the time to understand their unique situation.

Specially-trained nurses call members who may be at risk for, or currently dealing with, serious conditions like diabetes and high blood pressure. A Personal Nurse:

• Offers information – The nurse will help you identify health goals, explore treatment options with you, and guide you to resources so you can make informed decisions and take control of your health.
• Develops a personal relationship – You’ll be able to stay with your Personal Nurse as long as you remain a Humana member.
• Collaborates with you – The Personal Nurse service doesn’t replace your doctor. Instead, the nurse will help you communicate with your caregivers and work with your doctor so you can make decisions with confidence.
• Provides a sounding board – The Personal Nurse will help you gain control of your health – not just manage your symptoms. Sometimes having someone to talk to can mean the difference between your controlling a disease and it controlling you.

Personal Nurses don’t just provide education specific to your health. They also provide guidance about benefits, as well as pre- and post-hospitalization counseling, to help you fully understand your health benefit options and choices. Personal Nurses help you navigate the healthcare system, work better with your doctor, and make smart health decisions with confidence.

Personal Nurses work flexible hours, so the nurse can work with your schedule. During your phone calls, you will work with your nurse to decide future times you can talk. In addition, you’ll receive a welcome letter with your Personal Nurse’s business card and phone extension, so you also can call your Personal Nurse. All conversations are confidential.

The Bariatric Management Team

Humana’s bariatric management team guides members through the entire bariatric process.

In addition, members who are eligible for the Bariatric Management Program receive six months of bariatric care management after their operation, as well as post-surgery educational videos.

Bariatric Management Services

Humana’s bariatric management team explains benefits, options, and more:

• Benefits explanation
• Review of bariatric surgery medical necessity criteria
• Types of bariatric surgeries covered under the member’s plan
• Guidance in selecting in-network providers, including a bariatric surgeon and a facility that is a Bariatric Center of Excellence
• Pre-surgery educational video modules
• The surgery pre-determination process

Pre-Determination Requests

Your surgeon faxes or e-mails your clinical information to Humana’s bariatric management team requesting an authorization for surgery. The bariatric nurse reviews the clinical information as well as provider and hospital Bariatric Center of Excellence status. The bariatric nurse assures the medical necessity criteria has been met and, if necessary, consults with the bariatric regional medical director.

If you have a Health Maintenance Organization (HMO) plan, your primary care physician (PCP) can send your referral for bariatric surgery to the bariatric management team, who will enter it into the Humana system. Your PCP will also need to send a copy to the surgeon’s office.