Primary care physicians (PCPs), physician groups or independent practice associations (IPAs) acting on behalf of a PCP may request that Humana transfer a patient to another PCP. In some situations, if the PCP is with an IPA or physician group, the request can be to transfer the patient to an entirely different IPA or physician group. Generally, such requests are initiated because the patient and/or power of attorney (POA) or legal guardian have engaged in behavior that is disruptive, unruly, abusive or uncooperative to the extent that it seriously impairs the PCP's ability to furnish services to either the patient in question or other patients.
Note: Patients cannot be discriminated against in the delivery of health care services, consistent with the benefits covered in their policy, based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, sexual orientation, genetic information, source of payment, health status or participation in a federal program, such as Medicare or Medicaid. Accordingly, a transfer request may not be based on any of these factors, or on the amount or cost of the service that a patient requires. This list is not all-inclusive. PCPs are responsible for complying with all laws, regulations or other standards and policies that may apply.
Before initiating a transfer request, the PCP must solicit the patient’s or the patient’s POA/legal guardian's cooperation to resolve the unfavorable situation and document the results of the discussion(s).
Humana will evaluate and process the request for patient transfers as expeditiously as possible from the date on which Humana receives a request that contains all the required information and documentation.
Steps to initiate a patient transfer request: