Find a Humana Preferred (BHCG) provider by zip code

How are providers reviewed for participation in Humana Preferred (BHCG)?

Physicians identified as efficient in 20 specialties were evaluated by statistical methods, which identified and measured episodes of care costs, including physician, hospital, ancillary, pharmacy, and laboratory costs. There were additional criteria applied to large physician groups.

Not all Humana Preferred (BHCG) physicians were evaluated in the selected specialties or met the evaluation criteria. Some are included because they practice in a physician group practice which as a whole has met the criteria. Other physicians who have not been evaluated or meet the evaluation criteria are included in order to meet geographic access standards or practice in a unique sub-specialty needed in the network.

If a currently contracted Humana provider did not have enough data available to evaluate, the provider was included in the high performance network plan offering; however Humana will continue to track the provider’s data every six months and once a sufficient number of episodes are realized, the provider’s individual performance will be analyzed for continued participation in the high performance network. Physicians who are just starting their participation with Humana (never have been contracted with Humana as a provider) will be included in other Humana networks and products, except for the high performance network for a minimum of one year, allowing time for the provider to gain sufficient practice data to be analyzed based on Humana’s episode of care methodology.

What if my physician is in a group that is not a Humana Preferred (BHCG) participating group?

Individual physicians who are part of physician groups participating in Humana Preferred (BHCG) are always included if the group is included. Likewise, individual physicians who are with a group that is a nonparticipating group, are not participating if the group is not participating.

Will there be a cost to switch providers?

There may or may not be a cost involved in copying and transferring your records to another provider. That is determined by each individual provider’s office. If there is a cost incurred to transfer records, that cost is the patient’s responsibility since it does not fall under customary care and treatment as provided through your health care plan.

How do I transition my physician or health care in the middle of treatment for a particular condition?

This would be handled the same way it is handled today by an employer who makes a change in health plan benefits or health plan carriers from one plan year to the next. There are transition-of-care regulatory processes each company administers for employees who have transition of care situations.