TRICARE appeals are managed by Humana Military. The appeals process varies depending on whether the denial of benefits involves a medical necessity determination or a factual determination. 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.
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 issue or concern and include the following information:
Send grievances by mail to:
Humana Military Grievances
8123 Datapoint Drive, Suite 400
San Antonio, TX 78229
