- Part C— You have 65 days from the date of our Notice of Denial of Medical Coverage (or Payment) to appeal. After we receive the request, Humana will make a decision and send written notice within the following timeframes:
- Pre-Service Appeal—30 Calendar Days
- Post Service Appeal—60 Calendar Days
- Part D—You have 65 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to appeal (ask us for a redetermination). After we receive the request, Humana will make a decision and send written notice within 7 calendar days.
How to appoint a representative to file for you
For Humana to consider an appeal or grievance from someone other than you, we must have a valid authorization. You can appoint anyone as your representative by signing and sending us 1 of the following forms:
A representative who is appointed by the court or who is acting in accordance with state law also can file a request on your behalf after sending us the appropriate legal representative document. Note: You don’t need to complete an Appointment of Authorized Representative form if you provide a valid legal representation document with your request.
How to appeal a Part D late enrollment penalty from the Centers for Medicare & Medicaid Services (CMS)
If you received a Part D late enrollment penalty, you can appeal the decision with CMS if you meet certain conditions. Learn more about Part D late enrollment penalty reconsideration to see if you qualify, how to appeal this decision and more.
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 disagree with a coverage decision, call Member Services at the number on your ID card.