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

    Fax Number: 1-800-949-2961

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

    Coverage Redetermination Request Form
    Download PDF
    English

    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.

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