Humana — Denial Rates & Appeal Data
Compare against every insurer we track: denial rates ranked within reporting cohorts.
COVERAGE RIGHTS ROLLUP · CALCULATED FROM HUMANA PUBLIC DISCLOSURES
Rollup computed from Humana's 41 posted per-contract CMS-0057-F reports (32 Medicare Advantage contracts + 9 state Medicaid plans). Medicare-only: 6.9% denial rate, 64.7% of appeals overturned. Decision times are volume-weighted from whole-day per-contract values (approximate).
UNDERLYING SOURCE: HUMANA CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY
What these numbers mean for your denial
Coverage Rights calculated a 6.8% prior-authorization denial rate for the Medicare Advantage and Medicaid contracts in 2025. In the calculated Medicare Advantage and Medicaid contracts appeal scope, 53.2% were reversed — most denials that got challenged did not survive review. The underlying contract or plan figures were published by Humana; Coverage Rights performed the stated rollup.
The practical takeaway is narrower: an initial denial can change on review. These aggregate rates describe past decisions within the stated reporting scope; they do not predict the result of an individual appeal.
Your appeal deadline depends on your plan type
Humana runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:
Common questions
What is Humana's prior authorization denial rate?
Coverage Rights calculated a 6.8% prior-authorization denial rate for the Medicare Advantage and Medicaid contracts reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage and Medicaid contracts appeal scope, 53.2% were overturned.
How do I appeal a Humana denial?
Start with the appeal instructions in Humana's denial notice. An independent external, fair-hearing, or Medicare review may be available after the required internal review, but eligibility depends on the coverage program, plan funding, denial type, regulating jurisdiction, and whether the notice says internal review is exhausted. Use the pathway tool before choosing the next reviewer.
Where do these numbers come from?
Coverage Rights calculated the displayed rollup from Humana's public CMS-0057-F disclosures for 2025. The methodology note identifies the included reporting scope and weighting or aggregation method; source links lead to the underlying insurer-published records.