Humana Negotiations

I have a Humana health plan. What does this mean for me? 

For now, nothing changes. You should continue to visit Saint Joseph Health System hospitals, facilities, and physicians as you normally would. We are working hard to reach a new agreement before January 1, 2025 to avoid care disruption, but we need Humana to join us and put patients first. 

What is happening?  

Saint Joseph Health System is negotiating with Humana for a new agreement that appropriately covers the cost of the care we provide patients with Humana Medicare Advantage plans. Our current contract will expire January 1, 2025. Negotiations are a routine part of doing business, and we are working to improve our relationship with Humana. As one of the nation’s largest and most profitable health insurance companies, Humana has made it increasingly difficult for Saint Joseph Health System to invest in the medical innovations, technologies, and programs patients rely on by delaying patient care or refusing to pay for care altogether.

Why is this happening? 

As a trusted 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. But we can’t continue to do it alone. We cannot maintain access to the care and services patients depend on and need without a fair agreement from Humana.

When does the contract with Humana end? 

Our current agreement expires effective January 1, 2025.

Why are you notifying members now?

As we approach open enrollment season, Saint Joseph Health System wants to ensure that patients are fully informed about their options for 2025. Our goal is to secure a contract with Humana and minimize disruption to our patients’ care. However, we believe it is crucial to keep our community aware of the situation, should we encounter difficulties in reaching a fair agreement with Humana.

Which Humana health plans are affected by the negotiations? 

Patients with Humana Medicare Advantage health plans will be impacted.   

Which providers and facilities are impacted? 

All Saint Joseph Health System hospitals, facilities, and employed providers are impacted by these contract negotiations.  
•    Saint Joseph Health System – Mishawaka Medical Center
•    Saint Joseph Health System – Plymouth Medical Center
•    Saint Joseph Medical Group

What can I do to protect my in-network access to Saint Joseph Health System?  

While our negotiations with Humana continue, you can take these steps to protect your access to in-network care with Saint Joseph Health System: 

• If you are eligible for Medicare Advantage, the Annual Enrollment Period ends on December 7th and you can continue looking for plans through that time, even if you have already made a selection. We work with many health plans, including: 

  Accepted Insurance

• 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 undergoing active treatment, call the number on the back of your Humana insurance card to request a Continuity of Care form. This will help ensure that you can continue receiving in-network care at Saint Joseph Health System for a limited time but requires Humana’s approval.
• If you receive insurance through your employer, ask about health plans that include Saint Joseph Health System. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers. 
• If you have a Medicare Advantage plan or are a dually-enrolled patient through Humana, contact your Insurance Agent or Saint Joseph Health Insurance Services at 1.855.88.SJMED (1.855.887.5633) or visit https://www.sjmed.com/his before the Medicare Annual Open Enrollment Period, which begins Oct. 15, 2024 through Dec. 7, 2024.  If you have a Medicare Advantage plan administered by Humana, you can consider an alternative Medicare Advantage plan. We collaborate with many other health plans that will protect your in-network access to Saint Joseph in 2025. 
• Call the number on the back of your insurance card and express how this negotiation is impacting your access to the providers and services you know and trust at Saint Joseph Health System.

What other health plans will keep Saint Joseph Health System in my network next year?

We work with many other health plans offering Medicare Advantage products that will give you in-network access to Saint Joseph Health System for the 2025 benefit year:
o    Accepted insurance

What if I’m in the hospital when the contract ends? 

If you are already admitted to the hospital before January 1, 2025, you will be covered at in-network rates through the end of your inpatient stay.  

What if I have an elective procedure scheduled at a Saint Joseph Health System facility on or after January 1, 2025? 

We understand that some patients may have appointments scheduled on or after January 1. If possible, you should call your provider’s office to request that the appointment or procedure be rescheduled before January 1. If you are unable to reschedule your appointment or choose to keep your appointment, you may have to pay higher out-of-pocket costs for your care with Saint Joseph Health System if Humana forces us out of its provider network.  

What if I have an emergency on or after January 1 and Saint Joseph Health System is out of network? 

Patients will always have in-network access to our emergency rooms, regardless of our status with Humana. If you experience an emergency, you should always visit the nearest emergency room. Patients needing emergency care can receive in-network treatment until the patient is stable.  

How can I stay up to date on the negotiations? 

For the most up-to-date information, we encourage you to contact us by visiting sjmed.com/Humana or call our patient hotline at (574) 380-0044.

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:  

• If you are eligible for Medicare Advantage, the Annual Enrollment Period ends on December 7th and you can continue looking for plans through that time, even if you have already made a selection. We work with many health plans, including: 
  • Accepted insurance
• 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 undergoing active treatment, call the number on the back of your Humana insurance card to request a Continuity of Care form. This will help ensure that you can continue receiving in-network care at Saint Joseph Health System for a limited time but requires Humana’s approval.
• If you have a Medicare Advantage plan or are a dually-enrolled patient through Humana, contact your Insurance Agent or Saint Joseph Health Insurance Services at 1.855.88.SJMED (1.855.887.5633) or visit https://www.sjmed.com/his before the Medicare Annual Open Enrollment Period, which begins Oct. 15, 2024 through Dec. 7, 2024.  If you have a Medicare Advantage plan administered by Humana, you can consider an alternative Medicare Advantage plan. We collaborate with many other health plans that will protect your in-network access to Saint Joseph in 2025. 
• Call the number on the back of your insurance card and express how this negotiation is impacting your access to the providers and services you know and trust at Saint Joseph Health System.