Find Coverage Issues on Humana.com

When a member needs to know if Humana covers a cosmetic service, such as a tummy tuck, or if there is a question about whether Humana would authorize a new device or procedure, the answer is just a telephone call or online click away.

Coverage Issues are guidelines that represent the medical criteria identified through medical research as safe and effective. Humana’s coverage decisions regarding emerging medical technologies, devices and procedures are made by the Technology Assessment Department of Humana’s Innovation Center.

Creating medical policies
Humana’s medical policies are created with the following guidelines in place:

• Federal and state laws may dictate
  certain coverage
• Medical policies apply to most members, but individual consideration may be appropriate
• Member certificates or contracts determine benefit eligibility

“Humana does not want members to believe that a Coverage Issue would supercede the information in their Certificate of Coverage or any applicable mandates,” said Angela Keene, technology assessment process manager for Humana. “There are things in the member certificates that you won’t find in the Coverage Issue.”

Humana medical policies begin with a research analyst who conducts an extensive review of the medical issue using the following sources of information:

• Peer-reviewed medical journal
• The National Library of Medicine
• Specialty organization opinions and papers
• Medical research Web sites
• Medical textbooks

The research analyst then creates a position paper and presents it to Humana’s Technology Assessment Forum (TAF) for acceptance, rejection or modification. The TAF committee is made up of Humana medical directors, practicing physicians and representatives from Humana’s legal, claims, customer service and provider contracting departments.

Upon TAF acceptance, the position paper becomes Humana policy.

For more details about a specific Coverage Issue or to ask a question about a medical policy, go to www.humana.com, click on the “Providers” link, and then choose “Coverage Issues” under the “Health Care Resources” heading.

This section of the Web site receives 10,000 to 12,000 visitors a month, according to Keene. Humana welcomes the submission of comments and suggestions at the bottom of the Web page.

For specific member benefits, please do not submit a question on the Coverage Issues homepage. Instead, contact Humana Customer Service at (800) 448-6262.

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