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

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

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

No/Yes — Edmonds Family Medicine Only

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

Yes*

General Comments

* May select Edmonds Family Medicine (EFM) providers ONLY for PCP. Relationship is via Physicians Care Network (PCN), managed care subsidiary of The Polyclinic.

  • For all other Virginia Mason locations we are contracted (in-network) for specialty care referrals only.

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

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

* May select Edmonds Family Medicine (EFM) providers ONLY for PCP. Relationship is via Physicians Care Network (PCN), managed care subsidiary of The Polyclinic.

  • For all other Virginia Mason locations we are contracted (in-network) for specialty care referrals only.
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

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.

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.

 

Insurance Definitions