Important information for patients with Humana Medicare Advantage health insurance

Effective January 1, 2025, Humana Medicare Advantage members no longer have in-network access to Baylor Scott & White providers and facilities. While we will continue to negotiate, Humana Medicare Advantage plan holders will have to change providers or be faced with higher out-of-pocket costs.

Our patients are our top priority, and we are working to minimize any potential disruptions. You have four timely options to help ensure you have in-network coverage in the new year.

Options for retaining in-network coverage in 2025 

  • Continuity of care 

    If you are undergoing treatment, you may qualify for continuity of care, allowing you to receive in-network benefits and rates with Baylor Scott & White for up to 90 days after network changes. To apply, patients should call the customer service phone number on the back of their Humana insurance card to request a Continuity of Care Form. Once the form is completed and submitted to Humana, the request must be approved by Humana. Approval is not guaranteed and may take time to process. 

    Access the Continuity of Care Form here.
  • Switch to another insurer 

If your Medicare Advantage plan does not include Baylor Scott & White in its network for 2025, you may have options during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31. Changes made during this period will take effect on the first day of the month after the plan processes your request. If you’re considering switching plans, explore options at Medicare.gov or call 1-800-MEDICARE (1.800.633.4227). 

The insurers listed below will include Baylor Scott & White in their Medicare Advantage network across our geographies as of January 1, 2025:

For more details about specific plans, visit BSWHealth.com/InsuranceAccepted. 

  • Continue care with Baylor Scott & White at an additional cost 

If a patient chooses to stay with Baylor Scott & White under an out-of-network plan, Humana may pass along additional costs to you. 

  • Seek care from another provider or facility 

If your plan does not provide out-of-network benefits, you may need to transition to another in-network provider or facility. 

Frequently asked questions

  • How does this impact Baylor Scott & White patients?

    Effective January 1, 2025, Humana Medicare Advantage members no longer have in-network access to Baylor Scott & White providers and facilities. This could mean increased costs—or restricted access—for Humana Medicare Advantage patients who want to continue receiving care from a Baylor Scott & White provider or facility.

  • What do I do if I need to schedule a new appointment?

    Out of an abundance of caution to protect our patients’ expenses, we are no longer accepting appointments for Humana Medicare Advantage patients.

  • What if I am undergoing treatment or have a scheduled procedure?

    If you are undergoing treatment, you may qualify for continuity of care, which could allow you to maintain in-network benefits and rates for up to 90 days after Baylor Scott & White leaves Humana’s network. To qualify, members must obtain a continuity of care form from Humana or access the link at the top of this page. Once the form is completed and submitted to Humana, the request must be approved by Humana.

    For elective procedures, continuity of care approval is also required to avoid out-of-network costs.

  • What are my options during the Medicare Advantage Open Enrollment Period (MA OEP)?

    During the MA OEP (January 1 to March 31), individuals already enrolled in a Medicare Advantage plan can accomplish the following:

    • Switch to another Medicare Advantage plan that includes Baylor Scott & White in its network (with or without drug coverage).
    • Drop their Medicare Advantage plan and return to Original Medicare, with the option to enroll in a Medicare Part D drug plan.

    Changes take effect on the first day of the month after your new plan processes the request.

    If you’re considering switching plans, explore options at Medicare.gov or call 1-800-MEDICARE (1.800.633.4227).

    The insurers listed below will include Baylor Scott & White in their Medicare Advantage network across our geographies as of January 1, 2025: 

  • What if I have a medical emergency on or after the date the agreement ends, and Baylor Scott & White is out of network?

    If you experience a medical emergency, you should always visit the nearest emergency department. Humana will pay for services that its Medicare Advantage members receive to evaluate and stabilize an emergency medical condition, regardless of whether your care is received from an in-network or out-of-network emergency department.

  • Which plans are/are not included in this negotiation? 

    All Humana Medicare Advantage plans are included in this negotiation:

    Epic Code for Providers Plan Name
    412004 HUMANA MEDICARE PPO
    412006 HUMANA GOLD PLUS WELLMED
    412009 HUMANA MEDICARE ADVANTAGE SWHR
    412051 HUMANA MEDICARE ADVANTAGE
    412052 TRANSPLANT HUMANA MEDICARE

     

    The following commercial and Medicare Supplement Humana plans are NOT included in this negotiation:

    Epic Code for Providers Plan Name
    401052 TRANSPLANT HUMANA
    401054 HUMANA PPO POS
    401055 HUMANA HMO
    401056 HUMANA MEDICARE SUPPLEMENT
  • Which facilities are impacted?

    All Baylor Scott & White locations, including hospitals, urgent care, imaging centers, ambulatory surgery centers and free-standing clinics, are included in this negotiation. The negotiation also includes the following sites affiliated with Baylor Scott & White Health:

    Hospital-Surgical North Central Surgical Center
    Surgery Centers Bear Creek Surgery Center

    		Lone Star Endoscopy

    		North Texas Surgery Center

    		Park Cities Surgery Center

    		Sherman Endoscopy Center

    		SurgiCenter

    		Texas Endoscopy

    		Tuscan Surgery Center at Las Colinas
    Free-Standing Imaging Centers Advanced Imaging Center

    		Blue Star Imaging at The Star
    Urgent Care Centers NextCare