There’s a difference between a grievance and an appeal. A grievance is a complaint that expresses dissatisfaction with any aspect of the operations, activities or behaviors of Humana or its providers. A grievance isn’t submitted to dispute a denied claim or service; an appeal is used in these cases. Humana may take up to 30 days from the date it receives a grievance to respond. Visit our Medicare grievance page for detailed information on how to submit a grievance by mail, fax or phone.

Humana Medicare members also can use our online grievance form to submit a grievance.

An appeal is a request for Humana to reconsider a decision that the plan made about the member’s benefits. Some examples of what an appeal may involve are:  

• How a claim was denied, partially denied or paid
• A request or authorization for a medical service or medical equipment that was denied

Visit our Exceptions and appeals page for information on submitting appeals by mail, fax or phone.

Humana Medicare members also can use our online appeal form to submit an appeal on a denied medical claim only. This online form is not used for expedited appeals or appeals on denied requests or authorizations for a medical service or medical equipment. Once you submit your online appeal, Humana has 60 days to issue a decision.

There are 3 ways to submit a request: 

1. Submit a grievance online. 
   Online request for appeals, complaints and grievances
2. Print the form and mail or fax it.
   Appeal, Complaint or Grievance Form
   
   Fax number: 1-855-251-7594 
   
   Mailing address: 
   Humana Grievances and Appeals
   P.O. Box 14165
   Lexington, KY 40512-4165 
3. Call Customer Care at 888-908-6518
   You can also submit a grievance, get help filling out the form or check the status of a previously filed grievance by calling Customer Care. If you use a TTY, call 711. Puerto Rico members can call 866-773-5959, Monday – Friday, 2 a.m. – 2 p.m. 
   
   Multilanguage interpreter services

Once Humana receives an appeal, we’ll issue a decision within the following time frames based on what’s being appealed:

• Denied or partially denied medical claim: 60 calendar days
• Denied request or authorization for a medical service or medical equipment: 30 calendar days

A request for an expedited (fast) appeal can be submitted if waiting for a standard response time frame could seriously jeopardize the member’s life, health or ability to regain maximum function. Expedited appeals aren’t used for claims that have already been paid or denied. Visit our Medicare expedited appeals page for information on submitting an expedited appeal. Humana has 72 hours to respond with a decision after receiving an expedited appeal.

When a request for a grievance or appeal is submitted by someone other than a member, an AOR form or other type of legal representative document may be required. Visit our How to appoint a representative page for detailed information and the AOR Form. The completed form or document is mailed or faxed with the grievance or appeal if submitting by mail or fax. Use the appropriate mailing address or fax number below.

Humana Grievance and Appeal Department
P.O. Box 14165
Lexington, KY 40512-4165
Fax: 855-251-7594