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.
Grievances and appeals
Appeals
An appeal is a request for us to reconsider a decision we make. For example:
- Your doctor may ask us for permission for you to have a certain procedure
- Our medical director reviews the request and decides that we cannot give permission (called an adverse benefit determination)
- We send this information to your provider and/or to you
- You and/or your provider disagree with our decision
- You and/or your provider file an appeal
You may file an appeal orally or in writing. An appeal may take up to 15 days to process.
Grievances
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 call Customer Care and feel your wait time is longer than you want to wait
- You visit your doctor and are unsatisfied about an aspect of your visit
- You file a grievance with us to tell us about your experience
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.
Who can submit a grievance or appeal request?
You (member), a person you appoint, or your physician can submit a grievance or appeal request.
How can I submit the 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
You can use this form to:
- Submit a grievance about and tell us how you are dissatisfied with your experience
- File an appeal for a denied medical service, medical device, and/or prescription medication
After you file a grievance or appeal with our online form:
- You will get a confirmation email with details of your submission
You can get information about the status of any grievance or appeal you submit through our form by:
- Calling the number on the back of your member ID card to check the status of a grievance
- Using our
, opens new window to check the status of a medical appeal
In writing
If you submit a written request, please include the following:
- Your address, member ID, name, and telephone number
- Your service or claim number
- Your provider name
- The date of your service
- The reason you’re submitting the grievance or appeal 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
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.
Can I request an expedited (fast) appeal?
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
When can I request an expedited (fast) grievance?
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:
- Expedited (fast) appeal – Within 24 hours of receipt
- Standard appeal – Within 15 business days of receipt
- Expedited (fast) grievance – Within 24 hours of receipt
- Standard grievance – Within 30 days of receipt
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
Filing on behalf of another member
If you are filing a grievance or appeal on behalf of a member, you must submit a completed
Submitting an
An
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.
Humana Gold Plus Integrated