Understanding Your Humana Coverage
Humana is the second-largest Medicare Advantage insurer in the United States. They cover more than 17 million people through Medicare Advantage, employer plans, and individual policies. If you have joint pain from osteoarthritis, Humana likely covers the treatments you need.
This guide explains how Humana covers common joint pain treatments. We cover hyaluronic acid injections, cortisone shots, physical therapy, and more. You will learn what Humana requires for approval, how to avoid denials, and what to do if your claim is rejected.
Humana Plan Types
Your coverage depends on which type of Humana plan you have. Most Humana members have Medicare Advantage, but employer and individual plans are also available.
Medicare Advantage Plans (Most Common)
Humana is a leader in Medicare Advantage. Their popular plans include Humana Gold Plus, Humana Choice PPO, and Humana Honor. Medicare Advantage plans must cover everything Original Medicare covers. This includes hyaluronic acid injections for knee osteoarthritis.
Good News for Medicare Advantage Members:
Humana MA plans follow Medicare coverage rules for joint treatments. HA injections are covered when you meet medical necessity criteria. See our Medicare Advantage guide for more details on how MA coverage works.
Employer-Sponsored Plans
Some people get Humana through their job. These plans follow Humana medical policies but can vary by employer. Check your Summary Plan Description (SPD) for details about injection coverage. Your human resources department can explain your specific benefits.
Individual and Marketplace Plans
Plans purchased on Healthcare.gov or directly from Humana follow standard policies. Coverage for joint treatments is available when medical necessity is shown. Your metal tier (Bronze, Silver, Gold, Platinum) affects how much you pay out of pocket.
Covered Treatments Quick Reference
| Treatment | Coverage | Prior Auth | Visit Limits |
|---|---|---|---|
| Hyaluronic acid injections | Yes (with criteria) | Yes | Per series |
| Cortisone injections | Yes | No | 3-4 per year typical |
| Physical therapy | Yes | Usually no | Plan-specific |
| PRP injections | No | N/A | N/A |
| Stem cell therapy | No | N/A | N/A |
Hyaluronic Acid Injection Coverage
Humana covers hyaluronic acid (HA) injections for knee osteoarthritis when medical necessity criteria are met. This applies to both Medicare Advantage and most commercial plans.
Coverage Requirements
To qualify for HA injection coverage, you need:
FDA-Approved Brands Covered
Humana covers FDA-approved HA brands including Synvisc-One, Euflexxa, Supartz FX, Hyalgan, and Gel-One. Your doctor will recommend the best option based on your condition and plan preferences.
Prior Authorization Requirements
Humana requires prior authorization for hyaluronic acid injections in most plans. This is standard practice for Medicare Advantage insurers.
How Prior Auth Works
Includes diagnosis codes, imaging reports, and treatment history
Usually takes 2 to 5 business days for standard requests
Approval, denial, or request for more information
Your provider schedules your injection once approved
Tips for Faster Approval
- Make sure your doctor includes all imaging results
- Document every treatment you have tried (PT, medications, bracing)
- Use correct diagnosis codes (M17.0 for bilateral knee OA, M17.11 for right knee, M17.12 for left knee)
- Ask your provider to note how pain limits your daily activities
Keep Records: Save receipts and records from every treatment you try. Without proof that you completed conservative care, your HA injection claim may be denied.
Network Requirements
Using in-network providers saves you money and prevents billing problems. Humana offers different plan types with different network rules.
HMO Plans
Humana HMO plans require you to use in-network providers for non-emergency care. You will also need a referral from your primary care doctor to see a specialist.
PPO Plans (Humana Choice and Similar)
Humana PPO plans give you more flexibility. You can see out-of-network providers but will pay more. No referral is needed to see a specialist.
Cost Comparison by Network
| Factor | In-Network | Out-of-Network |
|---|---|---|
| Deductible | Standard plan deductible | Higher separate deductible |
| Coinsurance | 20-30% typical | 40-50% or more |
| Balance billing | Not allowed | Allowed in most states |
| Counts toward max | Yes | May not count |
Finding In-Network Providers
Use the Humana provider finder at Humana.com. Call the member services number on your card if you need help. Always verify a provider is in-network before your appointment.
Understanding Your Costs
What you pay depends on your specific plan, deductible status, and provider choice.
Medicare Advantage Plan Costs
Typical Humana Medicare Advantage Costs:
| Cost Type | Typical Range |
|---|---|
| Part B deductible | $0 in many plans |
| Specialist copay | $20 to $50 |
| Coinsurance | 20% after deductible |
| HA injection series (after deductible) | $50 to $300 |
| Out-of-pocket maximum | $3,500 to $8,850 |
Many Humana MA plans have $0 Part B deductible which can save you money
Commercial Plan Costs
| Cost Type | Typical Range |
|---|---|
| Annual deductible | $500 to $5,000+ |
| Specialist copay | $35 to $75 |
| Coinsurance | 20% to 40% |
| Out-of-pocket maximum | $4,000 to $9,100+ |
Questions to Ask Before Treatment
- Has my deductible been met this year?
- Is this provider in my network?
- Do I need prior authorization?
- What will my coinsurance be for this procedure?
Common Denial Reasons and How to Avoid Them
Understanding why claims get denied helps you prevent problems.
Top Denial Reasons
How to Appeal a Denial
If Humana denies your claim, you have the right to appeal. Many denials are overturned when patients provide the right documentation.
Humana Appeal Process
Step-by-Step Appeal Guide:
- Get the denial letter in writing with the specific reason
- Call member services within 60 days of the denial
- Gather documentation:
- Medical records showing OA diagnosis
- Imaging reports (X-ray or MRI)
- Records of all treatments tried
- Letter of medical necessity from your doctor
- Submit your appeal in writing to the address on your denial letter
- Request peer-to-peer review where your doctor speaks with Humana medical director
- Ask for external review if internal appeals fail
Expedited Appeals
If your condition is urgent, you can request an expedited appeal. Humana must respond within 72 hours for urgent cases. Your doctor can help request this if your pain is severe or worsening.
CenterWell and Humana Care Network
Humana operates CenterWell senior-focused primary care clinics. These clinics offer coordinated care that can benefit joint pain patients.
Benefits of CenterWell Clinics
- Same-day appointments often available
- Longer visit times with your doctor
- Care coordination with specialists
- Focus on preventive care and chronic condition management
Not all areas have CenterWell clinics. Check Humana.com to see if one is near you.
Contact Information
Keep these numbers handy:
- Medicare Advantage Members: 1-800-457-4708
- Commercial Members: Number on your Humana ID card
- Prior Authorization: 1-800-523-0023
- Provider Search: Humana.com
Key Takeaways
Summary for Humana Members
Good news:
- Humana covers hyaluronic acid injections for knee osteoarthritis
- Medicare Advantage plans follow Medicare coverage guidelines
- Appeals often succeed with complete records
What you should do:
Find Humana In-Network Providers
Locate providers who accept Humana and specialize in joint pain treatments.
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Thank You!
We've received your request. A provider specialist will contact you within 1-2 business days to help you find the right care.
What happens next?
- 1 We'll verify your insurance coverage
- 2 Match you with quality providers in your area
- 3 Contact you to discuss your options
Questions? Browse our guides:
How to Choose a ProviderReferences
- Humana Medical Coverage Policy - Viscosupplementation Coverage Guidelines.
- CMS Medicare Advantage Plan Requirements.
- Humana Evidence of Coverage Documents 2026.
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