File an appeal

Appeals must be filed with Humana Military within particular deadlines. Prior authorization denial appeals may be either expedited or non-expedited, depending on the urgency of the situation.

You or an appointed representative may request:

• Expedited reconsideration: an expedited reconsideration of a preadmission/preprocedure denial which must be filed by the beneficiary within three calendar days after the date of the receipt of the initial denial determination letter
• Non-expedited reconsideration: A non-expedited reconsideration of a denial must be filed no later than 90 calendar days after the date of the initial denial determination letter

For specific information about filing an appeal in your region, contact us.

To submit an appeal, send the below required information to hmhsrecon@humana.com:

• A letter of intent describing the reason for the appeal Beneficiary’s name, address and telephone number 
• Sponsor’s SSN 
• Beneficiary’s DOB 
• Beneficiary’s or appealing party’s signature (see below) 
• Copy of the previous denial determination notice 
• Any other appropriate supporting documents

Alternatively, you may submit your written request with the required information by fax or mail:

Humana Military Appeals
PO Box 740044
Louisville, KY 40201-7444

Fax: (877) 850-1046

File a grievance

A grievance is a written complaint or concern about a non-appealable issue regarding a perceived failure by any member of the healthcare delivery team—including TRICARE authorized providers, military providers, regional contractors or subcontractor personnel—to provide appropriate and timely healthcare services, access or quality, or to deliver the proper level of care or service. The grievance process allows full opportunity to report in writing any concern or complaint regarding healthcare quality or service. Any TRICARE civilian or military provider, TRICARE beneficiary, sponsor, parent or guardian, or other representative of an eligible dependent child may file a grievance. Humana Military is responsible for the investigation and resolution of all grievances. Grievances are resolved no later than 60 days from receipt. Following resolution, the party who submitted the grievance will be notified of the review completion. 

Grievances may include such issues as the quality of healthcare or services aspects like accessibility, appropriateness, level, continuity or timeliness of care, demeanor or behavior of providers and their staff, performance of any part of the healthcare delivery system, or practices related to patient safety. 

To file a grievance, you write a description of the of the issue or concern and include the following information: 

• Beneficiary’s name, address and telephone number
  
• Beneficiary’s date of birth
• Sponsor’s Social Security Number (SSN)
• Date, time and address of the event
• The nature of the concern or complaint
• Details describing the event or issue
• Any appropriate supporting documents

Send grievances by mail to:

Humana Military Grievances 
8123 Datapoint Drive, Suite 400 
San Antonio, TX 78229