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Any suggestions for appealing a Medicare part D (drug plan) denial by Humana based on off label use?

Do you know of any websites that are helpful?Thanks.

4 Answers

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  • ?
    Lv 7
    1 decade ago
    Favorite Answer

    Hopefully the doctor who prescribed the medication will work with you on the appeals process. You could try contacting your Local Area Agency on Aging to see if there are any local groups who can help you with the appeals process.

    Find your Local Area Agency on Aging at the Eldercare Locator

    http://www.eldercare.gov/Eldercare.NET/Public/Home...

    If you live in Florida, this group may have someone who can advise you on the appeals process:

    SHINE (Florida state health insurance assistance program for elder Floridians)

    http://www.floridashine.org/

    This group has decent information at their website:

    Medicare Interactive

    Medicare Rights Center

    http://www.medicareinteractive.org/

    Here is an article that gives some details on appealing a Medicare Part D denial:

    Senior Citizens Have an Appeal Process When Medicare Drug Plan Fails to Cover Needed Drugs

    Part D appeals process explained by Medicare Interactive

    http://seniorjournal.com/NEWS/Medicare/2009/200904...

    Good luck to you!

  • 1 decade ago

    Humana is notorious for denials but if you are persistent you can often win your appeal. Call your local office for the area agency on aging and ask for help from a case manager. They do not charge for this service.

    Last year I helped a ton of people to switch from Humana in Nov-Dec. I would suggest that you look for another plan during the yearly enrollment time frame.

  • 1 decade ago

    When you are on that merry-go-round, it is dizzying! I know because of a peculiar "rule" regarding late enrollment. There are however provisions for enrollment for someone whose insurance has changed due to the death of a spouse, and a move of residence resulting from the death. It is suppose to be a penalty. It would amount to slightly over $60 a year. The point is this is my second year with an AARP provider and last year, there was no issue. The money is suppose to go to my carrier with a coupon from and old type coupon book, they then send it to Medicare. HUH? It is now in "research!

  • We had to drop Humana due to them not paying for my DHs meds. Good luck.

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