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Ever since the pandemic, we’ve seen a flurry of activity around changing payer guidelines intended to give home-based patients a better quality of life. Humana is the latest payer to do this — announcing a preferred provider network for their Medicare Advantage plan members to receive respiratory supplies, mobility aids, wheelchairs and standard powered mobility, beds and support surfaces and ostomy, colostomy, urologicals and certain diabetic supplies.

Referring providers and patients affected by this change in network should have received a letter from Humana; however, we’ve heard that some providers are unaware or unclear on the details.

Here are 5 important facts you should know as well as steps you and your patients can take.

  • DME providers AdaptHealth and Rotech will now manage Humana’s Medicare Advantage health maintenance organization (HMO) business. And if you have a patient on rent, they will need to be transitioned to either of these organizations, depending on their state, by October 1.

  • AdaptHealth now covers: Alabama, Arkansas, California, Colorado, Connecticut, Washington, DC, Delaware, Georgia, Iowa, Illinois, Kansas, Massachusetts, Missouri, Maine, Minnesota, Missouri, North Carolina, North Dakoda, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakoda, Tennessee, Texas, Virginia, Vermont, Wisconsin.

Rotech now covers: Central North Florida, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Ohio and West Virginia

  • There are 9 states excluded from the new network. I suggest being proactive. You can pull their contract, make sure it fits your business needs and then stay close to the renewal/term dates.
  • The network change does not impact existing contracts for Medicare Advantage preferred provider organization (PPO) or other contracted lines of business.
  • As with any payer change, patients and providers have options. Keep reading for recommendations.

Discuss the network change internally. Your team can determine what’s best for your business and your patients and then you can start communicating that plan.

Reach out to your patients about this change. Reassure them that this is strictly a payer change and not a provider change. Let them know they can stay with you even if they change insurance from Humana to another available HMO and that you’re happy to continue servicing them if they chose to switch to another insurance that you’re contracted with.

Encourage your patients to take action. If a patient is unhappy with Humana’s network changes, encourage them to call 1-800-Medicare to voice their displeasure. Let them know that they can also call Humana.

As the industry continues to see changes to network guidelines, it’s important to keep in touch with your payers — and to have experts you can rely on. With Brightree’s Revenue Cycle Management (RCM) services, our team of RCM experts make sure you’re always in the know with education and support to weather the changes for the greatest success.

Find out more.

Ashley Brown

Ashley Brown,­ Sr. Director of Operations, Revenue Cycle Management, Brightree

Ashley brings 12 years of experience in the healthcare service industry to her role leading a team of payer analysts and intake specialists who help Brightree customers manage their businesses. Her extensive background includes operations, account management and process integration.


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