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  • Humana Lifts Prior Authorization Requirements for Physical Therapist Services

    Physical therapists (PTs) and patients may face plenty of challenges when it comes to dealing with private insurers, but for those who participate in the Humana system, preauthorization for physical therapy is no longer one of them. In a move strongly supported by APTA, the insurer lifted the prior authorization requirement for outpatient physical therapy, occupational therapy, and speech-language pathology.

    Humana made the announcement earlier this month, stating that the change was effective December 18, and applies to both commercial and Medicare Advantage policies. Other elements of the Humana benefit package remain unchanged, including visit limits, referral requirements for some plans, and medical necessity requirements. Prior to the change, PTs, occupational therapists, and speech-language pathologists were required to obtain preapproval from a utilization management/review vendor.

    APTA has long advocated for the elimination of prior approval as a much-needed change for patients and providers, but also as a way for the association and the insurer to demonstrate how more collaborative relationships can improve the health care landscape.

    "This is great news for patients and PTs," said Elise Latawiec, PT, MPH, APTA senior practice management specialist. "But this change also presents an even bigger opportunity. When we demonstrate how the elimination of prior authorization can reduce administrative burdens on PTs, decrease overall costs, and improve outcomes in the Humana system, we build an even stronger case that we can make to other insurers with prior authorization requirements. As a profession, we are committed to being responsible stewards of limited health care resources, and can show that we can be held accountable without the use of an intermediary gatekeeper."

    Providers working with Humana can get more detailed information on the change by contacting the Humana telephone number listed on a patient's member identification card.

    The Humana decision represents a reversal in a trend toward greater use of utilization management (UM) vendors among insurers. APTA works to keep its members informed on the UM environment through an online toolkit that debuted in 2017. The association is also bringing the profession's voice to the table by participating in various payer and utilization management advisory groups.


    • Unfortunately, now Humana audits preauthorized services and has been trying to claw back the few dollars they did reimburse providers. It's just a new way for them to discourage providers from treating their clients.

      Posted by Sean on 12/29/2017 4:59 PM

    • Do we know if this will be effective with the Humana military/Tricare "merger" Jan 1? Thanks

      Posted by Jen Corbeil on 12/30/2017 5:34 PM

    • Humana still reimburses worse than Medicare and even Medicaid in some states. And their visit limits are ridiculous. They have a little no way to go in being pro PT

      Posted by Eliza Andrews on 1/1/2018 11:01 PM

    • I would love a huge class action suit against Humana. They have taken back almost every payment they have made. The process of appeal is so time consuming and ineffective that they know you won’t do it. Absolutely detest them.

      Posted by Jille Dorler on 1/3/2018 11:23 PM

    • Humana Integrety division is double speak for stealing back payments. They use any excuse to claw back previously authorized payments and the appeals process is a circus where they recouped disputed paybacks from other patient payments during appeals process, lost documentation on some but not all of charts sent three times and when resent they determined that due to missing documentation, they won the appeal and would not return phone calls as to my protests for better transparency in the audit process and a request for third party review I would love a class action if others have had the same problem. As of now i am not seeing their pts and have campained for pts to choose another plan.

      Posted by William barnett on 1/4/2018 8:23 AM

    • Have you read the list of services they will not pay for? Aquatic Therapy, MFR, Graston, ? This does not affect if a Humana MAPS but does for all private

      Posted by Sue Simmerman on 1/4/2018 9:45 AM

    • Can anyone point me to a bulletin that lists aquatic therapy as needing authorization. I have been given the run around by multiple reps about this "list" they have but for some reason the only list I can find doesn't show aquatic therapy as needing auth. I am confused and frustrated by the complete lack of communication from this insurance company.

      Posted by Laura VanAmburgh on 1/18/2018 1:15 PM

    • Now that Humana is not outsourcing to Orthonet for OP PT services we are still being required to receive a referral authorization through the PCP, so in essence this is just a play on words. If our clinic is not familiar with a physician then it is nearly impossible for them to complete the necessary information needed and have them return it.

      Posted by Matthew Randel on 1/26/2018 10:51 AM

    • Reading the article, I was hopeful that Humana had changed their ways. Reading the comments and from my personal experience, it was reinforced that they have not. My reaction, when I hear that my patient is insured by Humana, is a clenching in the pit of my stomach followed an audible groan emanating from the part of my soul that is tortured by dealing with them. If they stop screwing you over in one way, it only means that they have developed a new, even more diabolical way of screwing you over. Personally, I would like to organize a national campaign whereby we all drive by the house of the CEO and throw bags of human waste on his lawn, giving him back what he has given us for years. The problem is, we deal with these entities from a position of weakness rather than a position of power. Until we make it so unpleasant for them to continue their dastardly ways, they will continue to screw us over, again and again.

      Posted by Brian Miller on 1/27/2018 8:15 AM

    • Hi William Barnett and Jille Dorler I have been going thru the same thing for the past three years, and the appeal process has not been easy. If you have had better luck please let me know .

      Posted by Astrid Arrieta PT on 2/27/2018 11:26 AM

    • Humana Medicare is now denying Aquatic therapy services as of 1/1/2018. Deemed experimental, yet they follow Medicare guidelines??

      Posted by heather e on 2/27/2018 3:48 PM

    • Goods news for humana insureds & may result in increased business. I know I’ve had it with BCBS & eviCore cutting off PT every couple of visits. Intentionally difficult to deal with.

      Posted by Susan Sardelli on 9/4/2019 3:22 PM

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