How do I?
Find a doctor or pharmacy
- Use our Find a Doctor service to quickly locate a doctor, hospital, dentist, vision provider, or pharmacy
Find a Doctor (link opens in new window)
- Call Customer Care at 1-800-787-3311 (TTY: 711), Monday – Friday , 8 a.m. – 8 p.m., Central time.
- Refer to your Provider Directory, which you can find on our Resources page, or complete this form (link opens in new window)> to request a print version be mailed to you. Humana will mail your directory within 3 business days, but please allow up to 2 weeks for it to arrive in the mail.
Find a dentist
Know if your prescriptions are covered
Refer to your Prescription Drug Guide, or call Humana Gold Plus Integrated at 1-800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time. The call is free.
Medicare-Medicaid members can request a printed drug guide be mailed to them. Fill out this form to receive a copy (link opens in new window). Humana will mail your directory within 3 business days, but please allow up to 2 weeks for it to arrive in the mail.
Get to a healthcare appointment
- For emergency transportation services, call 911.
- For non-emergency transportation, such as to a healthcare appointment, call 1-855-253-6865 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time. Note: Please call at least 3 days in advance when possible.
Enroll in Humana Gold Plus Integrated (Medicaid-Medicaid plan)
- Call the Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576), Monday – Friday, 8 a.m. – 7 p.m., Central time, and Saturday from 9 a.m. – 3 p.m., Central time, for information on joining or leaving the Humana Gold Plus Integrated (Medicare-Medicaid plan).
- Visit the enrollment broker (link opens in new window) website
Disenroll from Humana Gold Plus Integrated (Medicaid-Medicaid plan)
Request a Coverage Determination or Fast Coverage Determination
A coverage determination (sometimes called "coverage decision") is an initial decision we make about your benefits and coverage, or about how much we will pay for your healthcare services, items, or medicine. We make a coverage decision each time we decide what is covered for you and how much we pay.
To request a coverage determination, please complete the CMS Model Coverage Determination Request form (pdf opens in new window) .
You can return the form to us by fax or in the mail:
Fax number: 1-877-486-2621
Humana Clinical Pharmacy Review (HCPR)
P.O. Box 33008
Louisville, KY 40232-3008
File a grievance and/or an appeal
A grievance is a formal complaint or dispute expressing dissatisfaction with any aspect of the operations, activities, or behavior of Humana or its providers. A grievance does not involve decisions by Humana that are subject to an appeal, as outlined below. A grievance may take up to 30 days to process.
An Adverse Benefit Determination is when you do not agree with a decision we make related to your benefits. If this happens, you can request an appeal. An appeal is a request for us to reconsider our decision. You must file an appeal within 60 days of the Adverse Benefit Determination. An appeal may take up to 30 days to process.
If you need us to expedite the grievance or appeal process, call us. Learn more about filing a grievance or appeal with Humana.
To file a grievance or appeal with CMS, please complete the Medicare Complaint Form (link opens in new window)
Appeal an unfavorable prescription drug coverage determination
If you have received an unfavorable drug determination, you can ask for redetermination (appeal) by following the instructions given in the below Prescription Drug Plan Redetermination forms. Some reasons you may want to ask for a redetermination may be for drug list exceptions, coverage rule exceptions, or tiering exceptions.
Name someone who will represent me and be my advocate with the state and Humana
If you have trouble understanding your benefits, want to appoint a person to file a grievance, want to request a coverage determination, or want to request an appeal on your behalf, you and the person accepting the appointment must fill out an Appoint a Representative form (opens in new window) (or a written equivalent) and submit it with the request.
Your doctor or other provider may request a coverage determination, redetermination, or Independent Review Entity (IRE) reconsideration on your behalf without being an appointed representative.