Grievance and appeals

If you have a grievance or appeal related to your Humana Florida Medicaid plan or any aspect of your care, we want to hear about it and see how we can help.

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 orally or in writing within 60 calendar days from the date of the Adverse Benefit Determination. An Appeal may take up to 30 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. It does not involve decisions by Humana that are subject to an appeal, as outlined above. Grievances may take up to 90 days to process.

If you need an expedited appeal or grievance process, call us at 1-888-259-6779 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

In writing

To file a grievance or appeal, you must submit a grievance or appeal form to tell us what happened. Please provide as much information as you can so we can help resolve your issue.

Find grievance and appeal forms

You will need these things to get started:

• Your name, member ID, telephone number and address
• A completed Appointment of Representative (AOR) form, if you are submitting a complaint or appeal on behalf of a Humana member, or another type of representative form (see below section for more information)
• Your service or claim number
• Your provider name
• The date of your service
• The reason you’re submitting the appeal or complaint and what you want to happen
• Any supporting documentation, like receipts for services, medical records, or a letter from your provider that you want to include

Send your completed grievance and appeal form to:

Humana Florida Medicaid
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievance & Appeals Department

You will get a letter from us within 5 business days after we get your appeal or complaint.

By phone

Call Customer Care at 1-800-477-6931 (TTY: 711), Monday – Friday, from 8 a.m. – 8 p.m., Eastern time.

Find grievance and appeal forms

If you are filing an appeal or grievance on behalf of a member (other than yourself), you need an Appointment of Representative (AOR) form on file with Humana so that you are authorized to work with Humana on the member’s behalf.

You also may use other appropriate legal documentation that shows your authorized representative status (such as power of attorney)

AOR forms are active for one year from the date the form is signed by both the member and the representative, unless revoked.

Download, print, and complete the AOR form, found on the Document and Forms page; sign the form; and return it to us.

Find AOR forms

Send your completed form to:

Humana Florida Medicaid
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievance & Appeals Department