How To File Provider Complaints Against Humana and Get Reimbursed
Humana is a medical insurance provider that provides insurance plans to over 8 million Americans. Humana works with hundreds of healthcare providers and medical facilities on a nationwide basis which means that there is a high chance that you have interacted with Humana in some form or another.
Medicare and Medicaid Services have rated Humana's service as 4 out of 5 stars, but the people insured with the company beg to differ. There are hundreds of 1-star user reviews on various forums, with people claiming that Humana is a rip-off and that the company fails to live up to its promises.
Most issues with Humana boil down to billing disputes and prescription coverage problems. This can be a major problem for people whose only option is a certain treatment plan that Humana refuses to reimburse.
If you are a client of Humana and feel like you have been wronged, then you follow the official process outlined by the company and submit a formal grievance or appeal.
File an Official Complaint With the Humana Complaints Department
If you are dissatisfied with the services that were provided by the insurance company or the care given by one of Humana's providers, it is important to follow the company's official complaint procedure.
The formal complaint against Humana or one of its providers is called a grievance. You can find the detailed instructions on how to complete and file it on Humana's Grievances and Appeals page.
Keep in mind that it might take up to 30 days for Humana to process your grievance. If you're unsatisfied with the company's decision, you can file an appeal within 60 days of the Adverse Benefit Determination.
If you need additional information or want to expedite the process, you can call the Humana complaints department at 1-800-444-9137.
After completing the grievance or appeal form, you'll also have to mail it to the company:
Humana Grievance and Appeals Department P.O. Box 14546 Lexington, KY 40512-4546 Attn: Grievance & Appeal Department
Alternatively, you can fax the completed form to Humana at 1-800-949-2961.
If you’re a Medicare beneficiary, follow the instructions outlined on the Medicare Grievances page.
File Humana Health Insurance Complaints
If you can't get a satisfactory resolution to your complaint after contacting the company's representatives, you can request the assistance of the Kentucky Department of Insurance.
The official complaint against Humana can be submitted via the Kentucky Department of Insurance's website or by calling 1-502-564-3630.
You can also file a complaint against Humana with the following agencies:
- Kentucky Office of the Attorney General
- Better Business Bureau (BBB)
File Humana Insurance Complaints With Medicare
Medicare beneficiaries may include both those who have Humana supplemental insurance and those who have private insurance that covers hospitalization or medical services provided by Humana.
You can submit your complaint with Medicare using the online form or via email at Medicareombudsman@cms.hhs.gov.
Your complaint will be forwarded to the Medicare Part C Ombudsman or a Regional Ombudsman for further investigation.
If you don't have access to the Internet, you can also call Medicare's toll-free number at 1-800-633-4227.
File Humana Complaints With Medicaid
Medicaid beneficiaries who are dissatisfied with the care received from any of Humana's providers or the services that were provided by Humana itself can contact the Kentucky Office of Ombudsman.
You can file your complaint against Humana:
- Through the online form
- By calling the toll-free phone number: (800) 372-2973
File Humana Insurance Complaints With the BBB
The Better Business Bureau (BBB) is an independent organization that has no affiliation with any insurance company or service. The BBB provides assistance in resolving disputes between consumers and their insurers.
To file a complaint with the BBB, complete this online form using the instructions provided on the Bureau's website.
Sick of Humana Ignoring Your Insurance Complaint? Sue Humana in Small Claims Court
If you've exhausted all other options and can't get Humana to resolve your complaint, you can take the company to small claims court. Keep in mind that small claims courts have a limit of up to $5,000 for the value of your claim.
If you are going after Humana for reimbursement for out-of-pocket expenses, you can also file a lawsuit to recoup the amount that was paid out-of-pocket as a result of Medicare Advantage or Part D plan.
To start the legal process against Humana, you must correctly file a claim in the small claims court in your local jurisdiction, based on where you live. You can do this either by completing an online form if one is available or by filing a claim in person with the court's clerk.
Before the case reaches trial, you are required to send Humana a demand letter notifying the company that you will pursue legal action if they don't fulfill your request for reimbursement within 30 days.
The demand letter must include:
- Your name and contact information
- The specific service you're claiming to be entitled to reimburse
- The amount you're seeking to be reimbursed for the claim
- A specific time period that Humana has to respond
You should also prepare any evidence to support your claim, as well as gather all the correspondence between you and the company regarding the issue in question.
If Humana acts in bad faith and doesn't treat you fairly, you will be allowed to amend your complaint to include the additional claims of fraud or deceit, which is otherwise known as a "battery" claim.
Following a trial, the judge will make a judgment on whether Humana acted in bad faith and whether the fees were reasonable.
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