When can I file an expedited appeal on an adverse initial determination?
An expedited appeal can be requested if you believe that waiting for a decision under the standard time frame could seriously jeopardize the life or health of the member, or the ability to regain maximum function.
Who can submit expedited appeal requests?
- Part C – You (member), a person you appoint, or your physician.
- Part D – You (member), a person you appoint, your prescribing doctor, or other prescriber.
Refer to the How to appoint a representative section for additional information.
How can I submit the expedited appeal request?
(Part C and/or Part D) Call the expedited appeal phone line
You can submit an expedited appeal by calling 1-800-867-6601.
Puerto Rico members:
Call 1-866-773-5959
Our hours are 5 a.m. to 8 p.m. EST, 7 days a week.
You can submit an expedited appeal by mail. Download a copy of the , PDF opens new window and mail it to:
Humana Expedited Appeals Unit
P.O. Box 14165
Lexington, KY 40512-4165
Puerto Rico members:
Download a copy of the Appeal, Compliance or Grievance Form in
, PDF opens new window
or
, PDF opens new window
and mail it to:
Humana Puerto Rico Expedited Appeals Unit
P.O. Box 191920
San Juan, PR 00919-1920
Part D only – fax
Download a copy of the following form and fax it to Humana.
Fax number:
1-877-556-7005
Puerto Rico members:
Use the following form and fax number.
Fax number:
1-800-595-0462
Be sure to submit all supporting documentation, along with your expedited appeal request. Supporting documentation can be sent via fax at 1-855-251-7594. After we receive the request and all necessary information, Humana will provide a decision within 72 hours.