Humana

Information regarding accepted Humana insurance plans. Click on a plan below to learn more.

Contact your health insurance plan for information on covered services before your appointment.

Humana Insurance Plans

  • PPO Network

    Can I select a Virginia Mason primary care provider with this insurance plan?

    Yes

    Does this plan require pre-approval to see a specialist?

    No

  • HumanaChoice (PPO)

    Can I select a Virginia Mason primary care provider with this insurance plan?

    Yes

    Does this plan require pre-approval to see a specialist?

    No

  • Humana Gold Plus (HMO)

    Can I select a Virginia Mason primary care provider with this insurance plan?

    Yes

    Does this plan require pre-approval to see a specialist?

    Yes and No (please see comments)

    General Comments

    • May select any available VM primary care provider (PCP).
    • If selecting a VM or Polyclinic provider, may self-refer to any VM or The Polyclinic specialist (note some specialties may require a referral from primary care provider for clinical purpose).
    • If you have a VM or The Polyclinic PCP and are wanting to receive care outside of VM and The Polyclinic, an approved referral is required by your plan. Please note if the service is available within VM or The Polyclinic, a requested referral may be denied.
    • If selecting a PCP who is not with Virginia Mason or The Polyclinic, you will need a plan approved referral to be seen within VM.

    Note for mammogram and other preventive care (referenced in attached links), including DXA scans:

    • When using an in-network provider, referral authorization is not required for preventive services.
    • If there are findings and the service is coded as medical versus preventive due to the findings, an approved referral authorization is required. Also, if patient is having a repeat imaging or service, approved referrals are required.

    Humana Adult Preventative Care Guidelines

  • Humana Gold Plus (HMO SNP)

    Can I select a Virginia Mason primary care provider with this insurance plan?

    Yes

    Does this plan require pre-approval to see a specialist?

    Yes and No (please see comments)

    General Comments

    • May select any available VM primary care provider (PCP).
    • If selecting a VM or Polyclinic provider, may self-refer to any VM or The Polyclinic specialist (note some specialties may require a referral from primary care provider for clinical purpose).
    • If you have a VM or The Polyclinic PCP and are wanting to receive care outside of VM and The Polyclinic, an approved referral is required by your plan. Please note if the service is available within VM or The Polyclinic, a requested referral may be denied.
    • If selecting a PCP who is not with Virginia Mason or The Polyclinic, you will need a plan approved referral to be seen within VM.

    Note for mammogram and other preventive care (referenced below), including DXA scans:

    • When using an in-network provider, referral authorization is not required for preventive services.
    • If there are findings and the service is coded as medical versus preventive due to the findings, an approved referral authorization is required. Also, if patient is having a repeat imaging or service, approved referrals are required.

    Humana Adult Preventative Care Guidelines

  • Humana Physicians Care Network (Non-Medicare)

    Can I select a Virginia Mason primary care provider with this insurance plan?

    No

    Does this plan require pre-approval to see a specialist?

    Yes*

    General Comments

    * Referrals are no longer required by PCN for consultation/office visits. However, if patient is in need of imaging, treatment or other additional services, an approved referral IS required.

  • Humana Polyclinic (Non-Medicare)

    Can I select a Virginia Mason primary care provider with this insurance plan?

    No

    Does this plan require pre-approval to see a specialist?

    Yes*

    General Comments

    * Contracted for specialty care referrals only.