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.
Complaints, appeals and grievances
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).
Medicare
Part C coverage reconsideration
If you have received an unfavorable Part C determination, you can ask for a reconsideration (appeal).
Medicare
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.
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.