An appeal is a request for us to reconsider our initial decision, if you disagree with our decision to deny payment for an item or service. Please note that appeals should be written—however, we will accept oral appeals as required by law.
See your plan materials for more details about the time frame for appeals.
You can appeal our decision if you think:
- We're stopping or reducing coverage for an item or service
- We won't authorize coverage for an item or service we should cover
- We haven't paid (or fully paid) a bill you believe we should pay
- We denied an exception on a formulary prescription drug exception request*
Once we receive your appeal, we’ll investigate it and inform you of our decision.
For questions about the appeal process, please call the Customer Care phone number on your Humana ID card.
(*) The formulary exception appeal process may differ from other types of appeals. Please consult your plan document for details on the appeal process and the decision timeframes.