{"id":"humana","page":"https://escalate.alexgaoth.com/#/c/humana","html":"https://escalate.alexgaoth.com/c/humana/","generated":"2026-10-15","company":{"id":"humana","name":"Humana","aliases":["humana inc","myhumana","humana medicare"],"sector":"insurance_health","website":"https://www.humana.com","account_url":"https://account.humana.com","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-member-phone","type":"phone","label":"Employer group plan members without the ID card","value":"+1-866-427-7478","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Humana asks employer group members to call the number on the back of the ID card first.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-group-phone","type":"phone","label":"Employer group (small and large business)","value":"+1-800-232-2006","hours":"Mon-Fri 7 a.m.-7 p.m. Central","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"dental-vision-phone","type":"phone","label":"Individual dental and vision plans","value":"+1-877-877-1051","hours":"Mon-Fri 8 a.m.-9 p.m. Eastern","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Online chat after signing in to MyHumana","value":"https://account.humana.com","access":"login","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"appeals-page","type":"web_form","label":"Grievances, appeals and exceptions","value":"https://www.humana.com/member/exceptions-and-appeals","purposes":["claim_denial","poor_service"],"access":"open","source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"appeals-mail","type":"mail","label":"Humana Grievance and Appeals Department (Medicare appeal or grievance form)","value":"Humana Grievance and Appeals Department, P.O. Box 14165, Lexington, KY 40512-4165","purposes":["claim_denial","poor_service"],"notes":"Fax 888-556-2128. The same P.O. box is listed for the Humana Expedited Appeals Unit.","source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"},{"id":"appeal-form-pdf","type":"web_form","label":"Appeal or grievance form (PDF, mail or fax)","value":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","purposes":["claim_denial","poor_service"],"source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"},{"id":"expedited-appeals-phone","type":"phone","label":"Expedited appeals (Medicare)","value":"+1-800-867-6601","purposes":["claim_denial"],"notes":"For standard oral filings, call the Customer Care number on the back of the ID card. TTY 711.","source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"employer-appeals-mail","type":"mail","label":"Humana Grievances and Appeals (employer plans)","value":"Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"medicaid-help","type":"web_form","label":"Medicaid help and support options","value":"https://www.humana.com/medicaid/help","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"social","type":"social","label":"Humana help on X (Twitter)","value":"https://twitter.com/HumanaHelp","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"medicare-member-phone","note":"Use the number on the back of the member ID card."},{"rung":"written_complaint","channel":"appeals-online","note":"Internal appeal or grievance online, or by mail or fax with the appeal or grievance form. Employer plans use their own P.O. box."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for fully insured plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Appeal within 65 days of the Medicare denial notice, online, by mail or fax, or by phone for expedited cases.","evidence":["denial notice or EOB","member ID card","claim number","medical records","provider letter of medical necessity","receipts"],"steps":[{"do":"Check the claim and the EOB in MyHumana.","channel":"claim-status"},{"do":"File the appeal online, or mail or fax the appeal or grievance form with receipts, records or a letter from your doctor.","channel":"appeals-online"},{"do":"For a service not yet received where waiting could seriously harm health, ask for an expedited appeal with a statement from the provider, or call the expedited appeals line.","channel":"expedited-appeals-phone"},{"do":"Employer plan members mail the appeal to the employer plans P.O. box, or file orally through the number on the ID card. After the final internal denial, ask for external review or contact the state insurance department (fully insured) or the Department of Labor (self-funded).","channel":"employer-appeals-mail"},{"do":"Medicare members who still disagree follow the further Medicare appeal levels in the Evidence of Coverage."}],"facts":[{"kind":"deadline","claim":"For Humana Medicare Advantage (Part C), you have 65 days from the date of the Notice of Denial of Medical Coverage (or Payment) to appeal. For Part D, you have 65 days from the Notice of Denial of Medicare Prescription Drug Coverage to request a redetermination.","issues":["claim_denial"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"kind":"process","claim":"Humana decides Part C pre-service appeals within 30 calendar days, Part C post-service appeals within 60 calendar days, and Part D appeals within 7 calendar days.","issues":["claim_denial"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Humana's appeal or grievance form offers an expedited decision within 72 hours for services not yet received, when the provider supplies a statement that waiting could seriously harm the member's life, health or ability to regain maximum function.","issues":["claim_denial"],"source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the bill with the claim in MyHumana, then call member services.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the claim and EOB in MyHumana.","channel":"claim-status"},{"do":"Call member services about a claim processed wrongly, and ask the provider to rebill to the EOB amount.","channel":"medicare-member-phone"}]},{"issue":"surprise_medical_bill","summary":"Check the bill against the EOB, tell Humana and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":"claim-status"},{"do":"Tell Humana and the provider the bill may be a surprise bill."},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"facts":[{"kind":"policy","claim":"Humana's employer page lists group dental, vision, life and disability plans. It does not list employer group medical plans.","source":"https://www.humana.com/employer","last_verified":"2026-10-12"}],"known_blockers":["Claims and chat need a MyHumana login.","Medicaid plans are state-specific; use the Medicaid help page."],"notes":"Medicare Advantage, Part D and state Medicaid plans have their own appeal rules. Humana's employer offering on its website is group dental, vision, life and disability.","official_domains":["humana.com"],"security":{"never_asks":[{"kind":"policy","claim":"A Humana member fraud flyer says Humana will never offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information about you.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Medical identity thieves offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information, such as a Humana, Medicare or Medicaid ID number.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers claim to be from a clinic, doctor's office, insurance company or pharmacy to get a member's ID number. Humana says not to give a Humana, Medicare or Medicaid ID number over the phone before you verify the caller's identity.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers offer to send medicine or medical equipment. Humana says to accept medicine or medical equipment in the mail only if your primary care provider or another healthcare provider ordered or prescribed it.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana lists agent fraud such as enrolling people in a non-existent plan, offering cash payments to enroll, unsolicited door-to-door marketing of Medicare Advantage or prescription drug plans, and misrepresenting plans.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"siu-phone","type":"phone","label":"Humana Special Investigations Unit (report suspected fraud, waste and abuse)","value":"+1-800-614-4126","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Humana Special Investigations Unit referrals","value":"siureferrals@humana.com","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"ethics-help-line","type":"phone","label":"Humana Ethics Help Line (1-877-5-THE-KEY)","value":"+1-877-584-3539","hours":"24 hours a day, seven days a week","notes":"Staffed by external, non-Humana representatives. Calls can be anonymous. Online reports at www.ethicshelpline.com.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"humana","name":"Humana","sector":"insurance_health","website":"https://www.humana.com","account_url":"https://account.humana.com"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Appeal within 65 days of the Medicare denial notice, online, by mail or fax, or by phone for expedited cases.","evidence":["denial notice or EOB","member ID card","claim number","medical records","provider letter of medical necessity","receipts"],"steps":[{"do":"Check the claim and the EOB in MyHumana.","channel":{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"}},{"do":"File the appeal online, or mail or fax the appeal or grievance form with receipts, records or a letter from your doctor.","channel":{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"do":"For a service not yet received where waiting could seriously harm health, ask for an expedited appeal with a statement from the provider, or call the expedited appeals line.","channel":{"id":"expedited-appeals-phone","type":"phone","label":"Expedited appeals (Medicare)","value":"+1-800-867-6601","purposes":["claim_denial"],"notes":"For standard oral filings, call the Customer Care number on the back of the ID card. TTY 711.","source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"do":"Employer plan members mail the appeal to the employer plans P.O. box, or file orally through the number on the ID card. After the final internal denial, ask for external review or contact the state insurance department (fully insured) or the Department of Labor (self-funded).","channel":{"id":"employer-appeals-mail","type":"mail","label":"Humana Grievances and Appeals (employer plans)","value":"Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"do":"Medicare members who still disagree follow the further Medicare appeal levels in the Evidence of Coverage."}],"channels":[{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-member-phone","type":"phone","label":"Employer group plan members without the ID card","value":"+1-866-427-7478","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Humana asks employer group members to call the number on the back of the ID card first.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-group-phone","type":"phone","label":"Employer group (small and large business)","value":"+1-800-232-2006","hours":"Mon-Fri 7 a.m.-7 p.m. Central","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"dental-vision-phone","type":"phone","label":"Individual dental and vision plans","value":"+1-877-877-1051","hours":"Mon-Fri 8 a.m.-9 p.m. Eastern","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Online chat after signing in to MyHumana","value":"https://account.humana.com","access":"login","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"appeals-page","type":"web_form","label":"Grievances, appeals and exceptions","value":"https://www.humana.com/member/exceptions-and-appeals","purposes":["claim_denial","poor_service"],"access":"open","source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"appeals-mail","type":"mail","label":"Humana Grievance and Appeals Department (Medicare appeal or grievance form)","value":"Humana Grievance and Appeals Department, P.O. Box 14165, Lexington, KY 40512-4165","purposes":["claim_denial","poor_service"],"notes":"Fax 888-556-2128. The same P.O. box is listed for the Humana Expedited Appeals Unit.","source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"},{"id":"appeal-form-pdf","type":"web_form","label":"Appeal or grievance form (PDF, mail or fax)","value":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","purposes":["claim_denial","poor_service"],"source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"},{"id":"expedited-appeals-phone","type":"phone","label":"Expedited appeals (Medicare)","value":"+1-800-867-6601","purposes":["claim_denial"],"notes":"For standard oral filings, call the Customer Care number on the back of the ID card. TTY 711.","source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"employer-appeals-mail","type":"mail","label":"Humana Grievances and Appeals (employer plans)","value":"Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"id":"medicaid-help","type":"web_form","label":"Medicaid help and support options","value":"https://www.humana.com/medicaid/help","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"social","type":"social","label":"Humana help on X (Twitter)","value":"https://twitter.com/HumanaHelp","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}],"facts":[{"kind":"deadline","claim":"For Humana Medicare Advantage (Part C), you have 65 days from the date of the Notice of Denial of Medical Coverage (or Payment) to appeal. For Part D, you have 65 days from the Notice of Denial of Medicare Prescription Drug Coverage to request a redetermination.","issues":["claim_denial"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"kind":"process","claim":"Humana decides Part C pre-service appeals within 30 calendar days, Part C post-service appeals within 60 calendar days, and Part D appeals within 7 calendar days.","issues":["claim_denial"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Humana's appeal or grievance form offers an expedited decision within 72 hours for services not yet received, when the provider supplies a statement that waiting could seriously harm the member's life, health or ability to regain maximum function.","issues":["claim_denial"],"source":"https://assets.humana.com/is/content/humana/G-A_Form_Clean_2024pdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana's employer page lists group dental, vision, life and disability plans. It does not list employer group medical plans.","source":"https://www.humana.com/employer","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail or fax with the appeal or grievance form. Employer plans use their own P.O. box.","channel":{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims and chat need a MyHumana login.","Medicaid plans are state-specific; use the Medicaid help page."],"security":{"official_domains":["humana.com"],"never_asks":[{"kind":"policy","claim":"A Humana member fraud flyer says Humana will never offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information about you.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Medical identity thieves offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information, such as a Humana, Medicare or Medicaid ID number.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers claim to be from a clinic, doctor's office, insurance company or pharmacy to get a member's ID number. Humana says not to give a Humana, Medicare or Medicaid ID number over the phone before you verify the caller's identity.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers offer to send medicine or medical equipment. Humana says to accept medicine or medical equipment in the mail only if your primary care provider or another healthcare provider ordered or prescribed it.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana lists agent fraud such as enrolling people in a non-existent plan, offering cash payments to enroll, unsolicited door-to-door marketing of Medicare Advantage or prescription drug plans, and misrepresenting plans.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"siu-phone","type":"phone","label":"Humana Special Investigations Unit (report suspected fraud, waste and abuse)","value":"+1-800-614-4126","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Humana Special Investigations Unit referrals","value":"siureferrals@humana.com","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"ethics-help-line","type":"phone","label":"Humana Ethics Help Line (1-877-5-THE-KEY)","value":"+1-877-584-3539","hours":"24 hours a day, seven days a week","notes":"Staffed by external, non-Humana representatives. Calls can be anonymous. Online reports at www.ethicshelpline.com.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":26},"verified_from":{"page":26},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 26 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Medicare Advantage, Part D and state Medicaid plans have their own appeal rules. Humana's employer offering on its website is group dental, vision, life and disability.","warnings":[]},"billing_error":{"company":{"id":"humana","name":"Humana","sector":"insurance_health","website":"https://www.humana.com","account_url":"https://account.humana.com"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the bill with the claim in MyHumana, then call member services.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the claim and EOB in MyHumana.","channel":{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"}},{"do":"Call member services about a claim processed wrongly, and ask the provider to rebill to the EOB amount.","channel":{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}}],"channels":[{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-member-phone","type":"phone","label":"Employer group plan members without the ID card","value":"+1-866-427-7478","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Humana asks employer group members to call the number on the back of the ID card first.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-group-phone","type":"phone","label":"Employer group (small and large business)","value":"+1-800-232-2006","hours":"Mon-Fri 7 a.m.-7 p.m. Central","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"dental-vision-phone","type":"phone","label":"Individual dental and vision plans","value":"+1-877-877-1051","hours":"Mon-Fri 8 a.m.-9 p.m. Eastern","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Online chat after signing in to MyHumana","value":"https://account.humana.com","access":"login","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"medicaid-help","type":"web_form","label":"Medicaid help and support options","value":"https://www.humana.com/medicaid/help","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"social","type":"social","label":"Humana help on X (Twitter)","value":"https://twitter.com/HumanaHelp","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}],"facts":[{"kind":"policy","claim":"Humana's employer page lists group dental, vision, life and disability plans. It does not list employer group medical plans.","source":"https://www.humana.com/employer","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail or fax with the appeal or grievance form. Employer plans use their own P.O. box.","channel":{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims and chat need a MyHumana login.","Medicaid plans are state-specific; use the Medicaid help page."],"security":{"official_domains":["humana.com"],"never_asks":[{"kind":"policy","claim":"A Humana member fraud flyer says Humana will never offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information about you.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Medical identity thieves offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information, such as a Humana, Medicare or Medicaid ID number.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers claim to be from a clinic, doctor's office, insurance company or pharmacy to get a member's ID number. Humana says not to give a Humana, Medicare or Medicaid ID number over the phone before you verify the caller's identity.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers offer to send medicine or medical equipment. Humana says to accept medicine or medical equipment in the mail only if your primary care provider or another healthcare provider ordered or prescribed it.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana lists agent fraud such as enrolling people in a non-existent plan, offering cash payments to enroll, unsolicited door-to-door marketing of Medicare Advantage or prescription drug plans, and misrepresenting plans.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"siu-phone","type":"phone","label":"Humana Special Investigations Unit (report suspected fraud, waste and abuse)","value":"+1-800-614-4126","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Humana Special Investigations Unit referrals","value":"siureferrals@humana.com","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"ethics-help-line","type":"phone","label":"Humana Ethics Help Line (1-877-5-THE-KEY)","value":"+1-877-584-3539","hours":"24 hours a day, seven days a week","notes":"Staffed by external, non-Humana representatives. Calls can be anonymous. Online reports at www.ethicshelpline.com.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":26},"verified_from":{"page":26},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 26 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Medicare Advantage, Part D and state Medicaid plans have their own appeal rules. Humana's employer offering on its website is group dental, vision, life and disability.","warnings":[]},"surprise_medical_bill":{"company":{"id":"humana","name":"Humana","sector":"insurance_health","website":"https://www.humana.com","account_url":"https://account.humana.com"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Check the bill against the EOB, tell Humana and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":{"id":"claim-status","type":"portal","label":"View my claims (MyHumana)","value":"https://my2.humana.com/claims","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.humana.com/help","last_verified":"2026-10-12"}},{"do":"Tell Humana and the provider the bill may be a surprise bill."},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"employer-group-phone","type":"phone","label":"Employer group (small and large business)","value":"+1-800-232-2006","hours":"Mon-Fri 7 a.m.-7 p.m. Central","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"dental-vision-phone","type":"phone","label":"Individual dental and vision plans","value":"+1-877-877-1051","hours":"Mon-Fri 8 a.m.-9 p.m. Eastern","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Online chat after signing in to MyHumana","value":"https://account.humana.com","access":"login","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"medicaid-help","type":"web_form","label":"Medicaid help and support options","value":"https://www.humana.com/medicaid/help","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"},{"id":"social","type":"social","label":"Humana help on X (Twitter)","value":"https://twitter.com/HumanaHelp","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}],"facts":[{"kind":"policy","claim":"Humana's employer page lists group dental, vision, life and disability plans. It does not list employer group medical plans.","source":"https://www.humana.com/employer","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail or fax with the appeal or grievance form. Employer plans use their own P.O. box.","channel":{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims and chat need a MyHumana login.","Medicaid plans are state-specific; use the Medicaid help page."],"security":{"official_domains":["humana.com"],"never_asks":[{"kind":"policy","claim":"A Humana member fraud flyer says Humana will never offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information about you.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Medical identity thieves offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information, such as a Humana, Medicare or Medicaid ID number.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers claim to be from a clinic, doctor's office, insurance company or pharmacy to get a member's ID number. Humana says not to give a Humana, Medicare or Medicaid ID number over the phone before you verify the caller's identity.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers offer to send medicine or medical equipment. Humana says to accept medicine or medical equipment in the mail only if your primary care provider or another healthcare provider ordered or prescribed it.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana lists agent fraud such as enrolling people in a non-existent plan, offering cash payments to enroll, unsolicited door-to-door marketing of Medicare Advantage or prescription drug plans, and misrepresenting plans.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"siu-phone","type":"phone","label":"Humana Special Investigations Unit (report suspected fraud, waste and abuse)","value":"+1-800-614-4126","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Humana Special Investigations Unit referrals","value":"siureferrals@humana.com","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"ethics-help-line","type":"phone","label":"Humana Ethics Help Line (1-877-5-THE-KEY)","value":"+1-877-584-3539","hours":"24 hours a day, seven days a week","notes":"Staffed by external, non-Humana representatives. Calls can be anonymous. Online reports at www.ethicshelpline.com.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":26},"verified_from":{"page":26},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 26 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Medicare Advantage, Part D and state Medicaid plans have their own appeal rules. Humana's employer offering on its website is group dental, vision, life and disability.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"medicare-member-phone","type":"phone","label":"Medicare plans","value":"+1-800-457-4708","hours":"Mon-Fri 8 a.m.-8 p.m. local time","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"TTY 711. Members should use the number on the back of the member ID card when they have it.","source":"https://www.humana.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail or fax with the appeal or grievance form. Employer plans use their own P.O. box.","channel":{"id":"appeals-online","type":"web_form","label":"Online appeal or grievance form (Medicare Part C and Part D)","value":"https://resolutions.humana.com/grievances-appeals-forms/member-info","purposes":["claim_denial","poor_service"],"source":"https://www.humana.com/member/exceptions-and-appeals","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["humana.com"],"never_asks":[{"kind":"policy","claim":"A Humana member fraud flyer says Humana will never offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information about you.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Medical identity thieves offer \"free\" or \"low-cost\" healthcare services in exchange for identifying information, such as a Humana, Medicare or Medicaid ID number.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers claim to be from a clinic, doctor's office, insurance company or pharmacy to get a member's ID number. Humana says not to give a Humana, Medicare or Medicaid ID number over the phone before you verify the caller's identity.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Callers offer to send medicine or medical equipment. Humana says to accept medicine or medical equipment in the mail only if your primary care provider or another healthcare provider ordered or prescribed it.","source":"https://assets.humana.com/is/content/humana/SC_Detecting_Preventing_and_Reporting_Healthcare_Fraudpdf","last_verified":"2026-10-12"},{"kind":"policy","claim":"Humana lists agent fraud such as enrolling people in a non-existent plan, offering cash payments to enroll, unsolicited door-to-door marketing of Medicare Advantage or prescription drug plans, and misrepresenting plans.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"siu-phone","type":"phone","label":"Humana Special Investigations Unit (report suspected fraud, waste and abuse)","value":"+1-800-614-4126","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Humana Special Investigations Unit referrals","value":"siureferrals@humana.com","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"},{"id":"ethics-help-line","type":"phone","label":"Humana Ethics Help Line (1-877-5-THE-KEY)","value":"+1-877-584-3539","hours":"24 hours a day, seven days a week","notes":"Staffed by external, non-Humana representatives. Calls can be anonymous. Online reports at www.ethicshelpline.com.","source":"https://assets.humana.com/is/content/humana/Ethics%20Every%20Daypdf","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":26},"verified_from":{"page":26},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 26 sources are the organization's own pages or government sites.","dossier_last_verified":null},"dossier":null,"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}