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Complaints, appeals and grievances

If you’re unhappy with any aspect of your Medicare, Medicaid or prescription drug coverage, or if you need to make a special request, we want to help. For questions about the appeal process, please call the Customer Care phone number on your Humana ID card.

How to submit an appeal

Whether you are a Medicare member or receive insurance through your employer, you have the right to ask for an appeal. Explore your options below.

Medicare drug

Part D prescription drug coverage appeal

If you have received an unfavorable Part D prescription drug coverage determination, you can ask for a redetermination (appeal).


Part C coverage reconsideration

If you have received an unfavorable Part C determination, you can ask for a reconsideration (appeal).


Expedited appeals

If you believe that waiting for a decision under the standard time frame could seriously jeopardize the life or health of the member, you may request an expedited appeal.

Medical, drug and dental

Exceptions and appeals through your employer

If you’re unhappy with some aspect of your employer group insurance, you can file a grievance or appeal and seek a representative to act on your behalf.

File a grievance

If you are dissatisfied with any aspect of your Medicare plan, Customer Care, your healthcare provider or treatment facility, you can submit a grievance.

A woman's fingers typing on a laptop.

Request an exception

Exceptions are a type of coverage determination that must be requested through your healthcare provider. This can include requests like covering a non-preferred drug at a lower cost, covering drugs not currently on Humana’s Drug List, waiving certain limits and more.

Submit an appeal or grievance for a loved one

Legal representatives for Humana members may request a grievance or appeal on behalf of a Humana member. Learn more about the legal representation process and how to submit documentation.

Additional information

Helpful resources and support

Find tools and contact information, plus get answers to frequently asked questions.

Late enrollment penalty reconsideration

Learn more about late enrollment penalties and how to ask for a reconsideration.