Important Information For Patients Covered By Humana Medicare Advantage Plans
*Should updates occur regarding Humana's Network Status, they will be posted here*
Effective January 1, 2025, Pinehurst Medical Clinic will no longer be a participating network provider for patients covered by Humana Medicare Advantage plans. After that date, PMC will no longer be a part of Humana’s network, and your health care services under Humana Medicare Advantage will not be covered as an in-network benefit.
We understand this may be a confusing situation, and we want to provide as much information and assistance as possible. The Medicare Annual Enrollment Period (AEP) started October 15 and runs through December 7. PMC will remain in-network with Aetna, First Medicare Direct, and United Medicare Advantage plans. A full list of PMC alternative in-network Medicare Advantage plans is listed on the following site: https://www.pinehurstmedical.com/resources-category/insurance.
Please note PMC providers and employees cannot discuss or give advice about specific benefits or insurance plans, but here is how you can learn more and evaluate alternative in-network plans:
- Call an independent, licensed insurance agent who can help you fully understand this change, review your coverage needs, and suggest new plans which could be right for you. If you have an existing relationship with an insurance agent, please contact them to better understand your options. If you don't have an existing relationship with an insurance agent and would like to speak with a licensed agent familiar with this change, call (910) 542-8232. Advisors are available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 4 p.m.
- Visit seniorhealthconnect.com/PMC/Options to learn more about local plan options, watch informative videos, and connect with agents or health plans who can assist you.
You can also visit www.Medicare.gov to learn more about your options and the enrollment periods when you can change plans.
Frequently Asked Questions:
1. What if I am a state retiree and I have insurance through the State Health Plan Group Medicare PPO plan?
PMC has been able to work with the State Health Plan Group Medicare PPO plan to ensure continued state retiree access through 2025. If you have the State Health Plan Group Medicare PPO plan, you can continue to see Pinehurst Medical Clinic providers as an out-of-network benefit in 2025.
2. Does this mean that PMC will be out-of-network with Tricare for Life?
PMC will remain in-network with Tricare for Life. The change impacts Humana Medicare Advantage Plans and Humana Commercial Plans.
PMC has and continues to work diligently to reach an in-network provider agreement with Humana. PMC’s top priority is to identify avenues for our patients to continue our established care relationship in an in-network status beyond 2024.
PMC Providers Who Provide Services Under Agreement with FirstHealth Remain In-Network with Humana Medicare Advantage Plans
Please note, if you see a PMC provider who provides services under agreement with FirstHealth, they will still be in-network with Humana Medicare Advantage plans. The following is a list of those providers:
Cardiology
E. Scott Anderson, DO
Mahmoud Atieh, MD
Heather Blackburn, DNP
Tiffany Bonnecaze, MD, FACC, FSCAI
David Cowherd, MD
Keith Davis, MD
Stephanie Garner, FNP
Michael Gillespie, MD, MPH
Joseph Hakas, Jr., MD
Melissa Hill, FNP-C
Hematology & Oncology
Susan Bazinet, FNP-C
Bobbi Clark, AGNP-C
Laura Hanson, MD
Michelle Hunt, FNP-BC
Charles Kuzma, MD
Pulmonology
Adam Belanger, MD
Michael Pritchett, DO, MPH
