Help

How do I?

Need to find a doctor or make sure your prescriptions are covered? The information below will help answer questions you may have.

How do I find a Doctor?

Quickly locate a doctor, hospital, dentist, vision provider or pharmacy.

Provider Directories:

Note: If you need help finding a network provider and/or pharmacy, click here or call Customer Service at 1-800-787-3311 (TTY: 711), 8 a.m. – 8 p.m., Monday – Friday, Central time. If you would like a Provider/Pharmacy Directory mailed to you, click here (link opens in new window) .

How do I know if my prescriptions are covered?

You can click on our Prescription Drug Guide below, or call Humana Gold Plus Integrated at 1-800-787-3311 (TTY: 711), 8 a.m. – 8 p.m., Monday – Friday, Central time. The call is free.

Medicare-Medicaid members can request a printed drug guide be mailed to them. Fill out this form to receive a copy (link opens in new window). Humana will mail your directory within 3 business days, but please allow up to 2 weeks for it to arrive in the mail.

What if I need transportation?

For emergency transportation services, call 911. If you need a ride to a healthcare appointment that is not an emergency, call (855) 253-6865, Monday – Friday, 8am-8pm, CST. Call TTY: dial 711 to access local provider.

Note: Please call at least 3 days in advance when possible.

How do I enroll?

Call the Illinois Client Enrollment Services for information on joining or leaving the Humana Gold Plus Integrated (Medicare-Medicaid plan). They can be called at 1-877-912-8880 (TTY: 1-866-565-8576). They can be reached Monday – Friday from 8 a.m. – 7 p.m. Central time and Saturday from 9 a.m. – 3 p.m. Central time.

To visit the enrollment broker website, click here (link opens in new window) 

What are My Rights and Responsibilities if I decide I no longer want the Humana Gold Plus Integrated Plan?

Information on Requesting a Coverage Determination or Fast Coverage Determination

A coverage determination (sometimes called "coverage decision") is an initial decision we make about your benefits and coverage or about the amount we will pay for your medical services, items or drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay

https://www.humana.com/medicare/medicaid-dual/illinois/help/coverage-decision

To request a Coverage Determination, please complete the CMS Model Coverage Determination Request form. Clicking on the following link will open a zip file. Click on open and then click twice on the Model Coverage Determination Request Form pdf (link opens in new window) .

Grievances and Appeals

If you would like to learn more about filing a grievance or appeal with Humana, please click here:

To file a grievance or appeal with CMS, please complete the CMS form by clicking Medicare Complaint Form (link opens in new window) 

How do I name someone who will represent me and be my advocate with the state and Humana?

If you are having trouble with understanding your benefits, would like to appoint a person to file a grievance, request a coverage determination, or request an appeal on your behalf, you and the person accepting the appointment must fill out this form (or a written equivalent) and submit it with the request. Your doctor or other provider may request a coverage determination, redetermination or IRE reconsideration on the enrollee's behalf without having to be an appointed representative.