For Medicare Part C appeals, Humana can review appeal requests from a member, the member’s representative, or, in many instances, the member’s doctor. For Medicare Part D appeals, Humana can review appeal requests from a member, the member’s representative, or the member’s doctor or a non-physician prescriber.
For grievances of any type, Humana can review requests only from the member or the member’s representative.
A member’s representative is someone that a member designates on an Appointment of Representative form, or a legal representative that has been appointed by a court or under state law.
If you are a Humana member without a legal representative, you can give permission for another person to act as your representative for requesting an appeal or grievance on your behalf by completing and sending the Appointment of Representative Form. Both you and your representative must sign the form for it to be valid.
If you are a Humana member who has a legal representative, the representative can request a grievance or appeal on your behalf by sending documentation of the legal representation or the Appointment of Representative Form.