Humana Negotiations
Exempla Healthcare Dropped from the Humana Network as of October 15, 2012
Important Information for Patients with Humana Insurance
You Can Keep your Exempla Physicians and Facilities
Insurance Plans Accepted
Contact Us
Frequently Asked Questions
Important Information for Patients with Humana Insurance
Exempla Healthcare has been in talks with Humana for several months on a new contract that would keep Exempla Healthcare facilities and physicians in-network. After several months of negotiations and meetings with Humana, we are unable to come to terms for a new contract. This is not what we wanted, and we worked very hard to avoid this outcome.
As of October 15, Exempla Healthcare facilities and Exempla Physician Network providers are no longer part of the Humana’s contracted network providers and, therefore, may require higher co-pays for services.
The following facilities and physicians are affected:
- Exempla Saint Joseph Hospital (Denver)
- Exempla Lutheran Medical Center (Wheat Ridge)
- Exempla Good Samaritan Medical Center (Lafayette)
- Exempla Physician Network
- Exempla Behavioral Health at West Pines, a part of Exempla Lutheran Medical Center (Wheat Ridge) *Will be out-of-network beginning October 31, 2012
It is important for you to know that until October 15, 2012 nothing changes. You can continue to access care at all Exempla Healthcare facilities and with Exempla Physician Network physicians the same way you always have.
You Can Keep your Exempla Physicians and Facilities
- Consider Other Insurance Options
Exempla is included in-network by many other health insurers. You can consider other insurance options that allow in-network access to Exempla hospitals and physicians, if you have that option. See a list of insurance plans accepted.
- Commercial Plans
If you have commercial coverage, you can ask your employer about other insurance options or special open enrollment to include a second insurance option that guarantees in-network access. In addition, patients may also consider switching to a spouse’s health plan that includes Exempla physicians and hospitals.
- Medicare Advantage Plans
If you have a Medicare Advantage plan, you can ensure access to our facilities and physicians at in-network levels in the future by switching your Medicare Advantage plan during the open enrollment period. Open enrollment starts October 15 and you can pick a plan that includes your favorite Exempla hospitals and physicians in-network. Changes made during this time will be effective, January 1, 2013. Now is the time to make plans to change. We can help you navigate the change to another insurance provider. Call our Action Line at 303-674-1400 or 1-855-679-8467.
- Out-of-Network Benefits
Depending on your benefit plan, some patients may have out-of-network benefits so you will still have covered access to Exempla physicians and facilities on or after October 15. If you are a commercial member enrolled in a Humana PPO health plan, you most likely have out-of-network benefits with some cost sharing. In addition, Medicare Advantage plan, HumanaChoice (PPO), will allow you to see a provider out-of-network with some cost sharing. Contact Humana by calling the number on the back of your insurance card to find out your specific out-of-network benefits.
- Emergency Services
It is important to note that all patients can still access emergency services at Exempla hospitals, because emergency services are always covered at network benefit levels. If patients have an emergency, they should always go to the nearest emergency room.
* Humana Gold Choice (PFFS) allows patients to continue receiving care at the same level of benefits and costs. See more details below in Frequently Asked Questions.
** Also, some patients with chronic conditions or who are pregnant may be able to continue their care with us. But this is dependent on Humana’s continuity of care provisions, and we encourage you to contact Humana for more information.
Insurance Plans Accepted
Exempla Healthcare has contracts with many other major insurance companies. View a full list of insurance plans accepted here.
Contact Us
We recognize this situation creates anxiety for our patients. Our first concern is for our patients and ensuring you continue to receive high-quality, safe care. We can help you understand your options, navigate this change, answer questions and assist with any continuity of care issues.
Humana patients can call Exempla Healthcare’s Action Line at 303-673-1400 or 1-855-679-8647.
Frequently Asked Questions
Q: What’s going on between Exempla Healthcare and Humana?
A: Humana has issued Exempla a notice of termination for its Commercial and Medicare Advantage plans, effective October 15, 2012. This means that as of October 15, 2012, Exempla Healthcare facilities and Exempla Physician Network providers are no longer part of Humana’s contracted network providers and, therefore, may require higher co-pays for our services.
Q: Is there any chance you will come to an agreement before October 15?
A: Unfortunately no, because Humana has terminated our Commercial and Medicare Advantage contracts, effective October 15. This is not what we wanted and after several months of good faith negotiations, we worked hard to avoid this outcome.
Q: Which Exempla facilities and physicians are affected by this decision?
A: As of October 15, all Exempla Healthcare facilities and physicians are no longer part of Humana’s contracted network providers. The affected facilities and physicians are:
Exempla Saint Joseph Hospital (Denver)
Exempla Lutheran Medical Center (Wheat Ridge)
Exempla Good Samaritan Medical Center (Lafayette)
Exempla Physician Network
Exempla Behavioral Health at West Pines, a part of Exempla Lutheran Medical Center (Wheat Ridge) *Will be out-of-network beginning October 31, 2012
Q: Do I have access to Exempla facilities and physicians now?
A: Yes. Until Oct. 15, 2012 nothing changes. You can continue to access in-network care at all Exempla Healthcare facilities and with Exempla Physician Network physicians the same way you always have.
Q: What if I need emergency care?
A: It is important to note that all patients can still access emergency services at Exempla hospitals, because emergency services are always covered at network benefit levels. If patients have an emergency, they should always go to the nearest emergency room.
Q: Is there any other way I can keep my access to Exempla facilities and physicians?
A: Yes. There are several options.
If you have a Medicare Advantage plan, switch to another Medicare Advantage insurance plan that includes Exempla as an in-network provider. Patients can switch their plan during the open enrollment period for Medicare Advantage plans, which begins October 15, 2012, and runs through December 7, 2012. Changes made during this period become effective January 1, 2013. If patients receive their Medicare Advantage benefits as part of their retirement package, they should talk to their employer about considering other insurance plans that guarantee in-network access. Exempla is pleased to have relationships with all of the following Medicare health plans:
| United Healthcare Secure Horizons |
877-596-3258 |
| Aetna Medicare Advantage Plan |
800-832-2640 |
| Rocky Mountain Health Plans (Medicare Cost Plan) |
888-251-1330 |
In addition, some Humana Medicare Advantage Plans still provide access to Exempla:
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HumanaChoice (PPO) allows patients to go to doctors and hospitals that are out-of-network using their out-of-network benefits. The cost to the patient/member may be more but in many cases it is not more. Patients should verify their out-of-network benefits and costs by calling the telephone number on the back of their insurance card.
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Humana Gold Choice (PFFS) allows patients to continue receiving care at Exempla at the same level of benefits and costs. No prior authorization, prior notification or referral is required. However, the patient or Exempla may request an advance determination before a service is provided in order to confirm that the service is medically necessary and will be covered. Patients are still responsible for any of their required deductibles, copayment or coinsurance, which are no different whether they are in-network or out-of-network.
If you have commercial plan coverage, consider other insurance options. Exempla Healthcare facilities and physicians are included in-network by most other health insurers. You can talk to your employer about considering other insurance options that guarantee in-network access. In addition, consider switching to a spouse’s health insurance plan that includes Exempla physicians and hospitals. To view a full list of insurance plans accepted by Exempla. Some benefit plans, such as Humana’s PPO plan, provide coverage when patients see out-of-network providers, but their copayment, deductible or coinsurance costs may be higher. Patients should verify their out-of-network benefits by calling the telephone number on the back of their insurance card.
Q: How does this affect Medicare Supplement Insurance or “Medigap” (patients with Humana as a secondary payer to traditional Medicare)
A: There is no change. You can continue to see Exempla providers and use Exempla facilities.
Q: What if I still want to receive care from you once you are out-of-network? How much will that cost?
A: Your cost of care beginning Oct. 15, 2012 depends on your benefit plan and the type of care you receive. If you are a commercial member enrolled in a Humana PPO health plan, you most likely have out-of-network benefits with some cost sharing. In addition, some Medicare Advantage plans, such as HumanaChoice (PPO) plan, will allow you to see a provider out-of-network, but with some cost sharing. Humana Gold Choice (PFFS) will allow patients to continue receiving care at the same level of benefits and costs.
Contact Humana to find out your specific out-of-network benefits. The law prohibits us from offering special discounts or other accommodations to Humana members just because the contract ended. This means Humana will be billed our usual charges for any care we provide, and you will be responsible for whatever is detailed in your benefit plan for out-of-network services.
Q: What if I am pregnant or being treated for a chronic condition?
A: Continuity of care provisions are in place for particular patients with certain care needs. Some people, including women in their third trimester, may qualify for those provisions. However, this is dependent on Humana continuity of care provisions, and we encourage you to contact Humana for more information.
Q: What if I am in the hospital during the time your contract expires?
A: If you are hospitalized on or before Oct. 15, 2012, Humana will cover you on an in-network basis until you are discharged. We encourage you to contact Humana to review your exact coverage and benefits.
Q: What if I have a procedure, surgery or appointment scheduled on or after October 15, 2012?
A: If you have Humana insurance and are scheduled for an elective procedure on or after Oct. 15, 2012 you can still have your procedure done at our hospital, but you will be considered out-of-network. If you desire, and if there is availability, we can attempt to schedule your procedure, surgery or appointment before this date. We are committed to doing everything we can under the law to help you, including assistance understanding your rights and the cost of care.
Q: Who should I contact if I have questions about this?
A: We can help you navigate the change to another insurance provider. Call our Action Line at 303-673-1400 or toll-free at 1-855-679-8467.
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