Louisiana Medicaid: Grievances and appeals
Humana Healthy Horizons® in Louisiana members have grievance and appeal rights. If you have a grievance or want to appeal a decision we make, let us know.
Humana Healthy Horizons® in Louisiana members have grievance and appeal rights. If you have a grievance or want to appeal a decision we make, let us know.
Humana Healthy Horizons in Louisiana members can:
After we hear from you, we will see how we can help.
A grievance is a formal complaint or dispute expressing dissatisfaction with any aspect of the operations, activities, or behavior of Humana or its providers, such as:
You can let us know about your grievance by doing one of the following:
We will send you a letter within five (5) business days from the day we receive your grievance to let you know we received it.
We will then review it and send you a letter within 90 calendar days to let you know our decision. Negative actions will not be taken against:
You can also get help from others. People who can help you are:
If needed, we can help you file an appeal. You can also get help from others. People who can help you are:
You can file an appeal by:
We will send you a letter within five (5) business days from the receipt of your appeal request to let you know we received it.
After we complete the review of your appeal, we will send you a letter within 30 calendar days to let you know our decision. You or someone you choose to act for you may:
If you feel waiting for the 30-day timeframe to resolve an appeal could seriously harm your health, you can request that we make a decision faster: expedite the appeal. In order for your appeal to be expedited, it must meet the following criteria:
We make decisions on expedited appeals within 72 hours or as fast as needed based on your health. Negative actions will not be taken against:
If we do not change our decision or action because of your appeal:
You have the right to ask for a state fair hearing from the Louisiana Department of Health after you complete the Humana Healthy Horizons in Louisiana appeal process. You must ask for a hearing within 120 days from the date on our appeal decision letter.
The DAL will make its decision within 90 days of receipt of your request.
Along with the online application, you must provide a copy of the notice we send you with our appeal decision. According to the DAL, you can:
Division of Administrative Law – Louisiana Department of Health Section
P.O. Box 4189
Baton Rouge, LA 70821
See your Member Handbook for more information about the state fair hearing process
If you are filing a grievance or appeal on behalf of a Humana Healthy Horizons in Louisiana member, you must submit:
An AOR Form:
Send your completed form to:
Humana Healthy Horizons in Louisiana
Attn: Grievance & Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546
Fax your completed form to us at 1-800-949-2961.