Welcome to our Medicare Network Updates Page. Please utilize this page for the latest information regarding Medicare network changes affecting our hospital and providers. We understand that network changes can often be confusing or scary for beneficiaries, but we want you to know that are here to support you.
What is a network change?
Every so often and sometimes annually, networks can change which means certain facilities may become in or out of network. Typically, changes are effective after the open enrollment period to give patients time to consider their options. This year, St. James Parish Hospital received notification from Humana that our Medicare Advantage contract for our hospital and providers is being terminated effective December 31, 2024.
If you are eligible for Medicare and selected a Humana Medicare Advantage Plan you are affected by this change. Typically, if you have a Humana Plan, the Member ID on your insurance card will begin with the letter “H.” Our providers are working to send notification letters to their patients who have or may have had a Humana Medicare Plan.
Your personal Medicare Plan is your choice.
If it is important to you to see an in-network provider, we’ve included those options below. If you have an employer-sponsored Humana Medicare Advantage Plan, any changes will be at the discretion of your employer. Some employer-sponsored plans may offer out-of-network benefits. We encourage you to reach out to the insurance contact for your particular employer plan to inquire about out-of-network benefits. We are doing our best to identify and notify local employers who utilize Humana Medicare Advantage Plans for employees and/or retirees.
What does this mean if I have a Humana Medicare Plan?
If you have a Humana Medicare Advantage Plan, starting January 1, 2025, St. James Parish Hospital will be out-of-network and any services rendered will not be covered with in-network benefits.
This includes visits to hospital-employed providers (see below) inpatient stays, surgeries and outpatient services such: Lab Tests, MRIs, X-Rays, Stress Tests, IV Therapy, Sleep Studies, Occupational Therapy, Speech Therapy and Physical Therapy. This network change does NOT affect independent clinic visits to specialists such as Cardiologists, Orthopedic Surgeons, Gastroenterologists, Dermatologists, etc. that see patients in the Medical Plaza. However, any outpatient services/tests ordered at the hospital will be out-of-network.
Hospital Providers Affected Effective 1.1.2025:
- Dr. Cullen Ocmond
- Dr. Dylan Poche
- Dr. Jerry Poche
- Dr. Randall Poche
- Dr. Jarelle Scott
- Denise Louque, FNP
- Dr. Clay Boyd
- Dr. Jennifer Malsbury
- Wound Care Visits
Do I have out-of-network benefits?
Typically, HMO “Health Maintenance Organization” plans do NOT have out-of-network benefits. Certain employer plans (usually PPO plans – preferred provider organization) may have out-of-network benefits. We understand this can be confusing and can vary by plan, so it is very important to contact your particular insurance company via the phone number listed on your insurance card to inquire about your individual benefits.
What if I need emergency services?
Most health insurance plans cover emergency room (ER) visits and Urgent Care visits at out-of-network hospitals, as long as it’s a true emergency. In addition, the Affordable Care Act (ACA) requires insurance companies to cover emergency care from out-of-network providers such as doctors, technicians and specialists at in-network rates.
What Medicare plans are in network with St. James Parish Hospital and associated physicians?
Beginning January 1, 2025, St. James Parish Hospital and providers will be in-network with the following Medicare Plans:
- Original Medicare (Parts A and B)
- Aetna (Medicare Advantage Plan)
- Blue Advantage (Medicare Advantage Plan)
- Peoples Health (Medicare Advantage Plan)
- United Healthcare (Medicare Advantage)
How can I learn more about the Medicare Plans available in our area?
We are working with the State Health Insurance Assistance Program (SHIP) and local parish officials to help coordinate educational events at Senior Centers in St. James and St. John Parishes. Our goal is to offer these events once open enrollment begins in October. We will share dates, times and details once official plans are made.
When is my deadline for changing plans?
If you are interested in changing plans, this must be done during the Medicare Annual Enrollment period. This year’s open enrollment begins on October 15, 2024 and ends on December 7, 2024. We will partner to provide education and information, but you must choose a plan that works for your individual needs.
Who can I contact with questions?
We will do our best to keep this webpage updated with the latest changes as well as share new information via local newspapers and social media.
To contact the hospital with questions, call 225.258.2090. You will be asked to provide your name and insurance information so that a member of our financial services team can look up your records and call you back.
To reach our State Health Insurance Assistance Program (SHIP), call 1.800.259.5300 or 1.800.259.5301. Here is the link: https://www.ldi.la.gov/consumers/senior-health-shiip
Medicare Advantage plans vary, so we also encourage you to call the Humana number on your insurance card for specific coverage-related questions.
