If you believe the determination of a claim is incorrect, you may file an appeal on behalf of the covered person with authorization from the covered person. Some states may allow providers to file on their own behalf in certain circumstances. Please review the applicable state law for appeal rights.
The appeal will be reviewed by parties not involved in the initial determination. In order to request an appeal, you need to submit your request in writing within the time limits set forth in the medical insurance policy if filing on behalf of the covered person. If filing on your own behalf, you need to submit your written request within the time frame established by applicable state law. Please send the appeal to the following address:
Humana Grievance & Appeals Office
P.O. Box 14546
Lexington, KY 40512-4546
In Puerto Rico, please use this address:
Unidad de Querellas y Apelaciones
P.O. Box 191920
San Juan, PR 00919-1920
Please include with your request:
- A copy of the original claim
- The explanation of remittance showing the denial
- Any clinical records and other documentation that support your case for reimbursement
- An Appointment of Representative (AOR) Form or other legal documentation authorizing you to act on the covered person’s behalf (if you are filing an appeal on behalf of a covered person)
Please note that the commercial plan appeals process is the same for nonparticipating and participating providers.