Medicare exceptions and appeals

Medicare Expedited Appeals

When can I file an expedited appeal on an adverse initial determination?

An expedited appeal can be requested if you believe that waiting for a decision under the standard timeframe could seriously jeopardize the life or health of the member, or the ability to regain maximum function.

Who can submit expedited appeal requests?

  • Part C - You (member), a person you appoint, or your physician.
  • Part D - You (member), a person you appoint, your prescribing doctor, or other prescriber.

Refer to the How to Appoint a Representative section for additional information.

How can I submit the expedited appeal request?

  • (Part C and/or Part D) Call the Expedited Appeal Phone line. You can submit an expedited appeal by calling 800-867-6601. Puerto Rico Members, call 866-773-5959. Our hours are 8 a.m. to 8 p.m. Monday through Friday EST.
  • (Part D ONLY) Fax. Download a copy of the following form and fax it to Humana.

Coverage Redetermination Request Form Download PDF English (opens in new window)

Fax Number: 1-800-949-2961

Puerto Rico Members: Use the following form and fax number.

Coverage Redetermination Request Form Download PDF English (opens in new window)

Fax Number: 1-800-595-0462

Be sure to submit all supporting documentation, along with your expedited appeal request. Supporting documentation can be sent via fax at 1-855-251-7594. After we receive the request and all necessary information, Humana will provide a decision within 72 hours.

Humana is a Medicare Advantage organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in a Humana plan depends on contract renewal.

Enrollment reminder emails

Register now to receive free reminder emails about important enrollment deadlines.

Sign up today (opens in new window) 

Get help @HumanaHelp

Connect with Humana customer service on Twitter.

Follow HumanaHelp on Twitter (opens in new window) 

Take the confusion out of Medicare reform

With simple, straightforward terms, Humana helps you understand which healthcare reform changes may affect you and your wellness.

Find out what healthcare reform means to you