Important Alert Regarding Humana Insurance Coverage
At Sarasota Memorial Hospital (SMH), our highest priority is ensuring our community has access to affordable, high quality, comprehensive medical care. As the region’s only not-for-profit hospital, we are proud of our consistently high rankings among America’s top hospitals and our commitment to provide vital mission services that other local hospitals do not — including a life-saving trauma center, critical care nursery, pediatrics, maternity and more — at charges below our surrounding, for-profit hospitals.
Negotiating fair reimbursement rates with insurance companies, such as Humana, every few years is standard practice for medical providers and is essential to providing high-quality services in the future.
Despite ongoing contract negotiations, SMH has not been able to reach mutually acceptable terms to continue our agreement with Humana. The agreement expired April 1, 2019, making our hospital and network of outpatient and urgent care centers out-of-network providers for Humana members until a new agreement can be reached.
We know that Humana members have concerns. We hope the information on this page will help answer the most frequently asked questions.
If you would like SMH to remain in Humana’s approved network of providers, we encourage you to call or write the insurer about this change. Let them know how you have been affected and how important it is that SMH be part of your “in-network” coverage.
You can contact Humana:
Medicare Customer Service: 1-800-457-4708
Insurance through Employers: 1-800-448-6262
Humana members can also call the phone number on the back of their insurance card.
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** This information is not meant to persuade you into making any changes to your relationship with SMH or with any insurance company under which you are currently enrolled.
Frequently Asked Questions
Which Humana plans and SMH services are affected?
As of April 1, 2019, Sarasota Memorial Hospital as well as its outpatient and urgent care centers, are out-of-network providers for Humana members with Medicare Advantage, Medicaid and Employer/Commercial group plans. People with traditional Medicare and Medicare Supplemental plans are NOT affected.
What happens in emergency situations?
In emergency situations, you should always go to the nearest ER – no prior authorization is needed, and a patient’s financial responsibility is no higher if they go to an out-of-network emergency room. Except in rare circumstances, emergency services and care provided by SMH should be covered for Humana members receiving emergency and trauma services at Sarasota Memorial's main ER and freestanding ER in North Port at in-network rates. Humana members will be liable to pay their patient responsibility amounts under their plan.
What if I’m pregnant? Or need continuing care for an illness or injury?
There are provisions in state law to ensure continuing care at in-network rates for women who are pregnant and for patients in the midst of treatment for certain medical conditions, such as cancer. Although there are limitations, we will do everything we can to ensure continuity of care for those who are eligible.
Unfortunately, women and children who do not qualify for continuing care benefits likely will be required by Humana to seek hospital care in another community since Sarasota Memorial is the only hospital in Sarasota County with maternity, inpatient pediatrics and neonatal intensive care services.
Will this affect my relationship with my First Physicians Group doctor?
It might. Although First Physicians Group (FPG) is owned by Sarasota Memorial, FPG has separate contracts with Humana that are not affected by this change.
Until SMH reaches an agreement with Humana, services provided by your doctor at Sarasota Memorial or its network of outpatient centers (including laboratory, imaging, pain care, rehabilitation and urgent care centers) will be subject to higher out-of-pocket costs, unless Humana specifically agrees to cover the care at in-network rates.
You have the right to choose another hospital or healthcare provider for your care. If your FPG provider does not provide services at that facility, we will work with you to ensure a smooth transition of care.
Is there anything I can do to change Humana’s decision?
Humana members can let Humana know how important it is that SMH be in its approved network. Plan members can call the phone number on the back of their insurance card or refer to the contact information listed above.
You also have the right to receive care from another hospital or provider. Contact your insurer (the telephone number on your insurance card) directly about your choices. You may want to contact your insurer to see whether you are enrolled in health insurance for which SMH is a contracted provider.
Insurances We Accept
For Medicare-eligible patients, this change affects only Humana’s Medicare Advantage plans. It does NOT affect people with traditional (original) Medicare plans or traditional Medicare supplements.
In addition to accepting original Medicare plans, SMH currently has contracts as an in-network provider with the following Medicare Advantage and Medicare Traditional Supplemental Health Insurers (as of April 1, 2019):
• Aetna Health Inc.
• Blue Cross and Blue Shield of Florida Inc.
• Health Options Inc.
• UnitedHealthcare Insurance Co., UnitedHealthcare of Florida Inc. and certain other entities that are United affiliates.
Click here for information related to Medicare Open Enrollment for 2019.
If you have any questions about Medicare or the Medicare Advantage program, contact the Centers for Medicare & Medicaid Services (“CMS”) at 1-800-MEDICARE (1-800-633-4227). TTY users please call 1-877-486-2048. You can call CMS 24 hours a day, seven days a week, or visit the CMS website at www.medicare.gov. For assistance with Medicaid, you can call the toll-free number: 1-866-76ACCESS (1-866-762-2237).
For more information regarding Medicare Supplemental Insurance plans, you may contact CMS at 1-877-693-5236, or for Spanish, please call 1-850-413-1891. You can also visit the CMS website; click here.
Employer/Commercial Plan Members
SMH currently has contracts as an in-network provider with the following commercial health insurers (as of April 1, 2019):
• Aetna Health Inc.
• Blue Cross and Blue Shield of Florida Inc. and Health Options Inc.
• Cigna HealthCare of Florida Inc.
• UnitedHealthcare Insurance Co.y, UnitedHealthcare of Florida Inc. and certain other United affiliates
• AvMed Inc.
• Coventry Health Care National Network Inc.
• Sarasota Memorial Physician-Hospital Organization, d/b/a Gulf Coast Provider Network
• Interplan Health Group
• USA Managed Care Organization
Medicaid Plan Members
SMH currently has contracts as an in-network provider with the following Medicaid insurers (as of April 1, 2019):
• Molina Health Care of Florida, Inc.
• Simply Health Care Plans, Inc.
• Amerigroup Florida, Inc.
• Sunshine State Health Plan, Inc.
• Wellcare of Florida Inc., d/b/a Staywell Health Plan of Florida Inc.
• Freedom Health, Inc.
• Prestige Health Choice
If you have any questions about Medicaid, please call 1-866-76ACCESS or 1-866-762-2237 TTY users please call 1-800-955-8771. You can call Medicaid 24 hours a day, 7 days a week, or you can visit the Medicaid website at dcf.state.fl.us/service-programs/access/medicaid.
Sarasota Memorial Billing Advocacy Office: If you have questions about how this might impact your ability to seek care at Sarasota Memorial Hospital or our outpatient and urgent care centers, please call SMH’s Billing Advocacy Office at 941-917-1540 or 1-800-764-2455, weekdays from 8 a.m. to 5 p.m.
First Physicians Group: If you have questions about how this might impact care provided by your FPG physician, please contact FPG’s central office at 941-917-2600, weekdays from 8:30 a.m. to 5 p.m.
Medicare-eligible Patients: You can learn more about Medicare plan options by calling or meeting one-on-one with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased and confidential. Call the Florida Elder Helpline at 1-800-963-5337, or visit floridashine.org.