What is the appeals process for denied Medicare claims?

The appeals process for denied Medicare claims through Humana involves multiple stages. Firstly, if your claim is denied, you will receive a notice explaining the denial and instructions on how to initiate an appeal. The first stage involves requesting a review from Humana, where they will reevaluate your claim. If the decision is not in your favor, you can proceed to the second stage, which entails requesting an independent review by an independent organization approved by Medicare. This external review is binding, meaning both you and Humana must accept their decision. Throughout the appeals process, it is crucial to provide any additional evidence or documentation to support your case effectively. Humana aims to resolve appeals within specified time frames outlined by Medicare guidelines.