How to appeal a Humana denial
Start with the reason on your denial notice. Check your plan’s appeal route, then gather the records that answer the specific coverage rule.
No account or payment to check your route. You confirm the plan facts; published review outcomes do not predict your result.
Your appeal path depends on which kind of Humana plan you have. Find the matching plan below. Use the filing instructions on your actual notice.
Worth knowing before you start: 53.2% of appealed denials in Humana’s published Medicare Advantage and Medicaid contracts scope were overturned in reporting year 2025.
SOURCE: Humana published prior-authorization metrics ↗ · scope and methodology
Medicare Advantage
You have a Medicare plan run by a private insurer (an “MA” or “Part C” plan) — the card says Medicare Advantage, and the insurer is a company like UnitedHealthcare, Humana, or Aetna.
Level 1 — Plan reconsideration
The plan or designated delegated entity must receive the appeal within 60 calendar days after you receive the denial notice. Receipt of the notice is presumed 5 days after its date unless evidence shows otherwise (a 65-day notice-date default). The plan must use a different reviewer; medical denials need a physician reviewer.
Level 2 — Independent Review Entity (automatic)
If the plan says no again, it MUST forward your case to an outside reviewer automatically. You do nothing.
Level 3 — Administrative Law Judge
60 days to request a hearing if the amount in dispute meets the threshold.
Medicaid
Your coverage is Medicaid or CHIP — often through a managed care company (Centene, Molina, UnitedHealthcare Community Plan, and others run state Medicaid plans).
Step 1 — Plan appeal (managed care)
60 days to file with your managed care plan. Decision in 30 days, 72 hours expedited.
Step 2 — State fair hearing
Impartial state hearing officer, typically within 90–120 days of the plan's decision. You can represent yourself, bring anyone, and testify.
Aid paid pending
Appeal within 10 days of the notice and current services generally continue until the decision.