How do I?
Need to find a doctor or make sure your prescriptions are covered? The information below will help answer questions you may have.
Note: If you need help finding a network provider and/or pharmacy, click here or call Customer Service at 1-855-280-4002 (TTY: 711), 8 a.m. – 8 p.m., Monday – Friday, Eastern time. If you would like a Provider/Pharmacy Directory mailed to you, click here (link opens in new window) .
As a result of the VA CCC program end, these documents are no longer being updated.
A coverage determination (sometimes called "coverage decision") is an initial decision we make about your benefits and coverage or about the amount we will pay for your medical services, items or drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay
To learn more about the procedures for filing an organization/coverage determination click here.
To request a Coverage Determination, please complete the CMS Model Coverage Determination Request form (link opens in new window)
If you would like to learn more about filing a grievance or appeal with Humana, please click here
To file a grievance or appeal with CMS, please complete the CMS form by clicking Medicare Complaint Form (link opens in new window)
If you are having trouble with understanding your benefits, would like to appoint a person to file a grievance, request a coverage determination, or request an appeal on your behalf, you and the person accepting the appointment must fill out this form (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 the enrollee's behalf without having to be an appointed representative.