Utilization management is used to determine whether a service or treatment is medically necessary and appropriate for payment under your benefit plan. Humana does not reward or provide financial incentives to doctors, other individuals or Humana employees for denying coverage or encouraging under use of service.
If you have questions or concerns related to UM, staff are available at least eight hours a day during normal business hours.
Humana offers free language interpreter services to answer questions related to UM from non-English speaking members. TTY/TDD users can call 1-800-833-3301 or 711.
If you ever disagree with a coverage decision, you can ask to have your case reviewed through an independent review process. Call Member Service at the number on your ID card to find out how.