Grievances and appeals
You can appeal a decision that we make about your healthcare or share a grievance you have with any aspect of your healthcare. We want to hear about this from you and see how we can help.
You can appeal a decision that we make about your healthcare or share a grievance you have with any aspect of your healthcare. We want to hear about this from you and see how we can help.
An appeal is a request for us to reconsider a decision we make. For example:
You may file an appeal orally or in writing. An appeal may take up to 15 days to process.
A grievance is a formal complaint or dispute expressing dissatisfaction with any aspect of the operations, activities, or behavior of Humana or its providers. For example:
You may file a grievance orally or in writing. You can file a grievance at any time after the experience about which you are dissatisfied. A grievance may take up to 30 days to process.
You (member), a person you appoint, or your physician can submit a grievance or appeal request.
You can file a grievance or appeal our decision online, in writing, or by calling Customer Care at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time.
Online
Use our , opens new window to file a grievance or appeal. When filling out the form, please provide as much information as possible.
You can use this form to:
After you file a grievance or appeal with our online form:
You can get information about the status of any grievance or appeal you submit through our form by:
In writing
If you submit a written request, please include the following:
Send your completed grievance and appeal form to:
Humana
Grievances and Appeals Department
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievances & Appeals Department
You also can fax the completed form to us at 800-949-2961.
You will get a letter within 5 business days after we get your grievance or appeal form, to let you know that we received the form.
To file a grievance or appeal with CMS:
You or your doctor can request a fast appeal for situations in which the standard resolution time frame could seriously jeopardize your life, health, or ability to regain maximum function. To request a fast appeal:
Call: 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time
Fax: 855-336-6220
You or your doctor can request an expedited (fast) grievance when Humana has extended the time frame of an appeal or denies a request for an expedited (fast) appeal.
Be sure to submit all supporting documentation, along with your grievance or appeal request. After we receive the request, we will make a decision and send written notice within the following time frames:
If you need assistance, or for information on filing an aggregate number of grievances, appeals, and exceptions:
Call: 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time
Fax: 855-336-6220
If you are filing a grievance or appeal on behalf of a member, you must submit a completed , PDF opens new window or other type of representative form (e.g., power of attorney), along with the other information listed above.
Submitting an , PDF opens new window tells us that you are authorized to work with us on the member’s behalf.
An , PDF opens new window is active for 1 year from the date you and the members sign the form, unless revoked. Download, print, and complete an , PDF opens new window. This form requires a handwritten signature.
Send your completed form to:
Humana Inc.
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievances & Appeals Department
Fax your completed form to us at 800-336-6220.
You also can ask us to send you an , PDF opens new window.