Does Humana offer a true PPO ?

[Mike Siegal]

I guess only Humana brokers/agts can answer this.

Is Humana offering a true ppo----Last i heard they did..but didn't---?

Apparently Humana offers an 80% out of network 'option' but not in the fine text

• Is this option good for anywhere in the country?
• is this PPO only good for Humanas 'Extended network' ---- ?
• Does your MOOP cap still apply (if you go out of network)?

(waiting for a call-back from rep)....thought i would get some feedback from the group.

Anyone know...?

Thanks very much~

 

[StephanieCJ]

Not sure what an 80% out of network option is, but I was told with their PPO, you could use any Humana PPO contracted doctor in the US as in-network. That being said, I don't know that I have ever sold their PPO (other than the MA-only) because it was not cost effective in my area.

 

[Mike Siegal]

Not sure what an 80% out of network option is, but I was told with their PPO, you could use any Humana PPO contracted doctor in the US as in-network. That being said, I don't know that I have ever sold their PPO (other than the MA-only) because it was not cost effective in my area.

Yes...HUMANA MAP PPO

....so THAT'S not A True PPO.... (dr's must be contracted with Humana)

 

[StephanieCJ]

The PPO benefit is not for contracted doctors. For any contracted doctors nation-wide, you get the in-network pricing. Non-contracted doctors would be covered under the out-of -network benefit.

 

[Mike Siegal]

The PPO benefit is not for contracted doctors. For any contracted doctors nation-wide, you get the in-network pricing. Non-contracted doctors would be covered under the out-of -network benefit.

So it is a TRUE PPO;
-Doctors 'Not Approved' to do business with Humana are accessible under the 80% rule.
?

(i think there is a max- MOOP of 10k).

 

[StephanieCJ]

Moop varies between the PPO plans for out-of-network. Also, there are still some co-pays for some services out of network (subject to a potential deductible). I have never heard of an 80% rule so I don't know what you mean there.

 

[sman]

So it is a TRUE PPO;
-Doctors 'Not Approved' to do business with Humana are accessible under the 80% rule.
?

(i think there is a max- MOOP of 10k).

What is it you think a TRUE PPO is? Humana's PPO works like most any other PPO in that you have costs you pay using in-network providers and higher costs for out of network providers (assuming the out of network provider will accept the plans payment). That is to say, there really isn't an "80% rule" (I assume you mean the plan pays 80%). You can go to Humana's website and get a Summary of Benefits for the Humana plan(s) in your area. Simply look at the column for out of network costs and you can see what a person would pay for out of network services and what the MOOP is for out of network.

 

[Mike Siegal]

Moop varies between the PPO plans for out-of-network. Also, there are still some co-pays for some services out of network (subject to a potential deductible). I have never heard of an 80% rule so I don't know what you mean there.

What is it you think a TRUE PPO is? Humana's PPO works like most any other PPO in that you have costs you pay using in-network providers and higher costs for out of network providers (assuming the out of network provider will accept the plans payment). That is to say, there really isn't an "80% rule" (I assume you mean the plan pays 80%). You can go to Humana's website and get a Summary of Benefits for the Humana plan(s) in your area. Simply look at the column for out of network costs and you can see what a person would pay for out of network services and what the MOOP is for out of network.

I saw the 80% cost figure on the Med.gov. site. I believe it refers to out-of-network services like MRI's, out-of-network testing centers, etc. 80% refers to coverage pmt. 20% would be responsibility of insured.

*

 

[BibH]

In Ga Humana's 5216-241 which i sell a lot of for $28.30 a month is $0/$15 in our out of network . $2k full 0 copay dental,$300 glasses ,$125 otc benefit . The 5216-203 is $5/$35 and 40% copay Oon. Great plan for non lis and an easy sell.

 

[sman]

I saw the 80% cost figure on the Med.gov. site. I believe it refers to out-of-network services like MRI's, out-of-network testing centers, etc. 80% refers to coverage pmt. 20% would be responsibility of insured.

*

You just described Medicare Part B (80/20).

Again, go to Humana's website and download a Summary of Benefits for a MAPD PPO in your area. It's pretty clear as to the members responsibility for out of network services.