Grievances and appeals

Tell us how we can help with any issues you might have with your Kentucky Medicaid plan.

A doctor takes notes on a pad while talking to a patient.

Filing a grievance or appeal

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

Appeal vs. grievance

If you do not agree with a decision that your plan has made about your benefits, you can request an appeal. An appeal is a request for Humana to reconsider its decision. You must file an appeal within 60 days of the decision. Appeals 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 30 days to process.

If you need an expedited appeal or grievance process, call Humana Health Plan at 1-800-444-9137 (TTY: 711).

How to file a grievance or appeal

You’ll need to 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’ll 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
  • 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
Grievance and Appeals Department
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievance & Appeal Department

You will receive a letter within 5 business days after your appeal or complaint has been received to let you know we’ve received it.

Filing on behalf of another member

If you are filing an appeal or grievance on behalf of a member, you need an AOR Form on file with Humana so that you are authorized to work with Humana on the member’s behalf.

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

An AOR Form is active for 1 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. This form requires a handwritten signature.

Find AOR forms

Send your completed form to:

Kentucky Medicaid
Humana Medical Plan, Inc.
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievance & Appeal Department

Or fax your completed form to 1-800-949-2961.

You also have the right to ask for a state fair hearing from the Department for Medicaid Services after you have completed the Humana appeal process. You can do so in writing, by mail or fax. You must ask for a hearing within 120 days from the date on our appeal decision letter. Hearings must be submitted in writing with a signature.

To request a state fair hearing fax to 1-502-564-0223

Or you can write to:

Kentucky Department for Medicaid Services
Division of Program Quality and Outcomes
275 E. Main St., 6C-C
Frankfort, KY 40621

More on grievances and appeals

You can learn more about the grievance and appeal process in your member handbook.

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