Frequently Asked Questions (FAQs)

Find answers to commonly asked member questions below.

Question about Emergencies

Question About Lost Member ID Cards

Question About Medical Necessity

Question About Pre-certification (Authorization)

Claims

Where do I submit claims for services from non-network providers?

For Services from a Non-Network Provider:

Mail the forms provided to you by your mental health provider along with evidence of any payment made. Please ensure the following information is on the bill:

  • Insured's and patient's ID numbers and the group number
  • Total charge, diagnosis code and service code
  • Date of service, provider's name, provider license and tax ID number

For All Other Claims

See our Claims section for mail, e-mail addresses and contact numbers.

What do I do if my claim is denied?

Humana Behavioral Health offers you the right to appeal any claims decision. Claims appeals should be made no later than sixty days from the date you receive your claims decision.

Request an Appeal Via E-mail, Phone or Mail

What is an independent review organization (IRO)?

If you do not agree with the outcome of the Humana Behavioral Health appeal process, you may be eligible for a review by an independent review organization (IRO). Please refer to the attachments to your denial letter or contact customer service for instructions and information on the availability of an IRO.

Contacting Humana Behavioral Health

What hours can I call Humana Behavioral Health?

Our customer service helpline provides toll-free access 24 hours a day, 365 days a year. You can call this number on your member card to get help with finding network providers, checking your claims, and verifying benefits and eligibility. Also, see Contact Us.

Who am I going to talk with when I call Humana Behavioral Health?

You will initially speak with a customer service representative who will provide the answers you need or put you in touch with someone who can help you.

What kind of information will I need when I call Humana Behavioral Health?

You will need your insured's ID number, group number and employer's company name. This information should be listed on your insurance card.

Emergencies

What do I do if I have an emergency?

If you or a covered family member are in a life-threatening situation, call 911 or go to the nearest hospital. The hospital will contact us through the 800 number on your benefit card, and a licensed professional Humana Behavioral Health staff member will assist you.

In consultation with hospital staff, the Humana Behavioral Health care manager will authorize the appropriate level of care. Depending on your benefit plan, it may be necessary for you to be transferred to a facility that is participating in Humana Behavioral Health's network.

Lost Member ID Cards

What if I lose my card?

Contact your employer or health plan for a new card.

Medical Necessity

What is medical necessity?

Medical necessity is the type or level of care deemed necessary or appropriate by a qualified mental health professional to maintain or restore daily functioning.

Decisions are based on guidelines, criteria, and clinical rationale, which can be obtained free of charge. You can also request the diagnosis and treatment codes and descriptions. Please send your written request to the address below: Humana Behavioral Health Attn: Information Requests 2101 West John Carpenter Freeway Irving, TX 75063-3228 Fax: 866-771-0574 or contact us at 877-264-2548.

Pre-certification (Authorization)

What is pre-certification?

Pre-certification is the process of notification and approval of treatment (inpatient and outpatient) and services before they are delivered.The pre-certification process ensures communication with the treating provider and/or you prior to the procedure and verifies that your plan covers the procedure, the provider and the facility you are accessing.

Is pre-certification required?

It is best to call Humana Behavioral Health to determine if your plan requires pre-certification. When you call, our customer service representatives will refer you to a clinical care manager who will help you with the pre-certification process, if it is required.

Privacy

How does Humana Behavioral Health handle privacy issues?

Humana Behavioral Health follows national and state laws regarding confidentiality to protect your privacy. Also, see our Privacy Policies section.

Humana Behavioral Health Providers

Where does Humana Behavioral Health have providers?

Humana Behavioral Health has network providers and practitioners located across the country in all 50 states. A Humana Behavioral Health representative can assist you in selecting an appropriate practitioner or facility near you. You may also locate a Humana Behavioral Health practitioner or facility near you with our online provider directory.

Find a provider with the Humana Behavioral Health Provider Lookup Tool (link opens in new window) 

Do I have to see a Humana Behavioral Health network provider?

Depending upon your particular benefit plan, benefits may be paid at a reduced rate or not at all, if you see an out-of- network provider. It is recommended that you call Humana Behavioral Health to verify your benefits prior to seeing a physician.

What if my provider isn't in the Humana Behavioral Health network?

You can do two things if you would like to nominate your provider to be part of the Humana Behavioral Health network:

  • Ask your provider to call the Humana Behavioral Health Provider Relations Department to learn more about joining our provider network.
  • Call the toll-free number on your insurance card and request your provider be contacted about joining the Humana Behavioral Health network.

What do I do if I have problems with my provider?

Please call the Humana Behavioral Health number on your card and give specific information to the customer service representative. The information will be forwarded to the appropriate department for an immediate review. In addition, a Humana Behavioral Health representative can assist you in deciding whether you need a referral to a different Humana Behavioral Health provider in your area.

Do I have to call Humana Behavioral Health to see a behavioral healthcare provider?

It is best to call Humana Behavioral Health to determine if your plan requires authorization prior to seeing a practitioner.