Humana member rights

Get the care you deserve. Find information about authorizations, low-income subsidy and more.

A friendly Humana employee explains rights to a Humana member.
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Your rights and responsibilities

The rights and responsibilities statement reminds members and healthcare providers of their roles in maintaining a productive relationship.

 

Medical Authorizations

Find out if your doctor or hospital needs advanced approval to cover costs for certain medical procedures, services, or medications. 

Pharmacy authorizations

Before filling a prescription for some medications, you may have to get approval from Humana to make sure the medication is covered under your plan. 

Disenrollment and cancellation

Discover when and how to cancel or disenroll from your Humana Medicare Advantage or prescription drug plan.

Exceptions and appeals

Find answers to your questions and concerns about filing an exception, appeal or grievance and appointing a representative.   

Medical organization determination

You have the right to ask Humana to pay for items or services you think should be covered. If you are a Medicare member, this is called a request for an ‘organization determination.

Low income subsidy

You may be eligible for “Extra Help” or a low-income subsidy with payments for your prescription drug plan, deductible and copayments. Access forms online.

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Quality Improvement (QI) program

Humana wants to provide you with quality care so we have developed a program to make sure we are always improving. Find more information in the 2018 Quality Improvement program description overview,PDF opens new window or call 1-800-4-HUMANA (1-800-448-6262) for a printed copy.

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New medical technology

Humana follows strict guidelines to make sure the care you are getting is clinically sound and of your best interest.

Utilization Management

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.

More resources

FAQs

Learn more about plans through answers to frequently asked questions.

Help and support

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

Ask Humana

Humana members can ask us anything. Find answers through our smart search tool.