Humana Negotiations
🚨Alert - Saint Joseph Health System is out of network with Humana effective January 1, 2025.
Patients with Humana Medicare Advantage Plans Can Still Make Changes
Medicare Advantage plan members can make changes to their existing plan, disenroll from their current plan, switch to a new plan or return to Original Medicare during the Medicare Advantage Open Enrollment Period which runs from Jan. 1 to Mar. 31. This is a separate enrollment opportunity from the Medicare Advantage Annual Enrollment Period that ended in December.
If you decide to make a change, you can explore other plan options. Your new plan benefits will be in effect for the rest of the year. We work with many health plans, where can be found here.
Learn more and find plans at medicare.gov.
Continuity of Care: Humana has informed us that the Continuity of Care eligibility period expired on March 31, 2025. Eligibility for Care coverage is determined by Humana. To find out if you still qualify due to ongoing treatment, you can contact Humana directly to request and exception.
Patients with a PPO Plan May Have Out-of-Network Benefits
Call the number on the back of your Humana insurance card to inquire about out-of network benefits and your share of costs.
We believe Health Comes First
We know how important it is for you and your family to receive care from the trusted doctors, nurses and staff at Saint Joseph Health System . As a not-for-profit, local care provider, we work tirelessly to care for our patients and communities. We also continue to reduce costs and implement efficiencies to ensure we can continue providing top-quality care to our patients. We are asking health insurers to put patients first just like we do. Without them doing their part, access to care is at risk. Saint Joseph Health System provides high-quality care in our community while doing our part to make health care affordable – in 2023 alone, we've invested $48 million. Meanwhile, Humana has made it increasingly difficult for us to invest in the medical innovations, technologies, and programs patients rely on by delaying patient care or refusing to pay for care altogether. As one of the nation’s largest and most profitable health insurers, we need Humana to protect patient care and access.
For months, we've worked diligently to find common ground with Humana to ensure your access to Saint Joseph Health System remains uninterrupted. We rely on fair payment from health insurers so we can sustain the high-quality care patients like you depend on and need.
We will not give up trying to reach a fair agreement with Humana. We know how important it is for you and your family to continue receiving care from the trusted doctors, nurses, and staff at Saint Joseph Health System. Below is important information for you to know, including how to tell Humana that your health care and relationship with Saint Joseph Health System is important. We are asking Humana to put patient health over their wealth. For us, Health Comes First.
Frequently Asked Questions
You deserve access to high-quality health care
At Saint Joseph Health System, we believe our community members deserve options for high-quality care, and we are proud to be one of Indiana’s most trusted health care providers. That’s why we’re working to protect our ability to serve patients for generations because health comes first.
If you do not find the answers to your negotiation-related questions on this site, please contact us directly via this website through our contact us page or call our patient line at 574-380-0044. This website will be updated as our negotiations continue, so please check back for the most up-to-date information.
Unfortunately, Saint Joseph Health System will no longer be included in Humana’s network on January 1, 2025. This impacts patients who are covered by a Humana Medicare Advantage plan for the 2025 benefit year. Below, we’ve provided in-depth information to help our patients understand how this may affect them:
What is happening?
Saint Joseph Health System has been working diligently to secure a new agreement with Humana that more appropriately covers the true cost of the care we provide to patients with a Humana Medicare Advantage plan.
At this time, our existing agreement has expired. Unfortunately, Saint Joseph Health System will no longer be included in Humana’s network on January 1, 2025. This impacts patients who are covered by a Humana Medicare Advantage plan for the 2025 benefit year. This means you may pay more out-of-pocket for the health care services you receive through Saint Joseph Health System moving forward.
Who is affected by the negotiation?
Patients who receive health insurance coverage through Humana Medicare Advantage plan are affected. Humana no longer includes Saint Joseph Health System in your provider network on January 1, 2025.
Which providers and facilities are impacted?
Saint Joseph Health System hospitals, facilities, and employed providers are impacted by these contract negotiations.
• Saint Joseph Mishawaka Medical Center
• Saint Joseph Plymouth Medical Center
• Saint Joseph Medical Group
What is Saint Joseph Health System doing to reinstate its in-network status?
We will not give up trying to reach a fair agreement with Humana. We know how important it is for you and your family to continue receiving care from the trusted doctors, nurses, and staff at Saint Joseph Health System. Your voice can make a difference. Call Humana and urge them to restore your in-network access to Saint Joseph Health System and its doctors.
If I’m not covered by a Humana health plan, does this impact my insurance too?
No, our out-of-network status only affects patients covered by a Humana health plan. Saint Joseph Health System is in-network with many health plans, found here.
What if you’re receiving ongoing treatment at Saint Joseph Health System?
If you're receiving ongoing treatment, Humana has informed us that the Continuity of Care eligibility period expired on March 31, 2025. Eligibility for Continuity of Care coverage is determined by Humana. To find out if you still qualify due to ongoing treatment, you can contact Humana directly to request an exception.
What if I’m in the hospital on/after January 1, 2025?
If you are already admitted to the hospital prior to January 1, 2025, you will be covered at in-network rates through the end of your inpatient stay.
What if I have an upcoming procedure at Saint Joseph Health System on/after January 1, 2025?
We understand some patients may have appointments scheduled on or after January 1, 2025. If this is the case, you should call Humana at the number on the back of your health insurance card to determine whether they will cover your procedure through Continuity of Care provisions.
What if I have a medical emergency on/after January 1, 2025?
You should always seek emergency care if you believe you are experiencing a medical emergency at the closest location to you. Regardless of our status with Humana, your care will be considered in-network until you are stabilized.
If my care is impacted, what should I do?
- Never delay care. You will always have in-network access to our emergency department. Regardless of our network status with Humana, you should always visit the closest emergency department if you experience a medical emergency.
- If you're receiving ongoing treatment, Humana has informed us that the Continuity of Care period expired on March 31, 2025. Eligibility for Continuity of Care coverage is determined by Humana. To find out if you still qualify due to ongoing treatment, you can contact Humana directly to request an exception.
- Call the number on the back of your insurance card and urge Humana to restore your in-network access to Saint Joseph Health System and its doctors.
- If you enrolled in Medicare Advantage for the 2025 benefit year, you may have options. For additional information about your Medicare insurance options, you can contact your insurance agent or use the free, no-obligation resources available at Saint Joseph Health Insurance Services or by calling 1.855.88.SJMED (1.855.887.5633). We work with Medicare and many health plans including:
What if I have more questions?
Call us at 574-380-0044 to speak with someone directly or visit sjmed.com/humana
What You Can Do
There are ways to protect your ability to affordably access Saint Joseph Health System in 2025, regardless of our status with Humana. Consider the following:
- Never delay care. You will always have in-network access to our emergency department. Regardless of our network status with Humana, you should always visit the closest emergency department if you experience a medical emergency.
- If you're receiving ongoing treatment, call the number on the back of your Humana insurance card to receive more information about Continuity of Care—you may be able to continue in-network care at Saint Joseph Health System.
- Call the number on the back of your insurance card and urge Humana to keep your in-network access to Saint Joseph Health System and its doctors.
- If you enrolled in Medicare Advantage for the 2025 benefit year, you may have options. For additional information about your Medicare insurance options, you can contact your insurance agent or use the free, no-obligation resources available at Saint Joseph Health Insurance Services or by calling 1.855.88.SJMED (1.855.887.5633). We work with Medicare and many health plans including: