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Humana: Medicare Advantage denial & appeal rates
Humana · 20% of MA enrollment
In 2024, Humana denied about 5.5% of the prior-authorization requests it reviewed. When members appealed, 64.7% of those denials were overturned — yet only 11.6% of denials were appealed at all. ~81% of appealed MA prior-authorization denials are overturned, so a denial is rarely the final word.
Humana’s posted coverage policies
Insurers must post the medical policies they use to decide coverage. These are the ones most relevant to lab, imaging, and facility denials — quote the matching policy in your appeal.
| Service category | Policy | Updated |
|---|---|---|
| Advanced imaging (MRI/CT) | Advanced Imaging of the Abdomen and Pelvis / Chest / Head and Neck / Spine - MA | Abd/Pelvis Eff 5/12/2026 Rev 6/1/2026; Chest Eff 5/12/2026 Rev 6/1/2026; Head/Neck Eff 2/10/2026 Rev 3/2/2026; Spine Eff 4/14/2026 Rev 5/1/2026 |
| PET / oncologic imaging | not located (no standalone PET title under P/F) | — |
| Skilled nursing facility (SNF) | not located as standalone MA policy | — |
| Inpatient rehab facility (IRF) | Inpatient and Long Term Acute Care Hospital Services - MA | Eff 10/14/2025 Rev 11/3/2025 |
| Home health | not located as MA policy (Medicaid variants exist) | — |
| DME (general) | DME split into device-specific MA policies (e.g., Power Wheelchair Accessories; Prosthetics; Orthotics) | Power Wheelchair Acc. Eff 4/14/2026 Rev 5/1/2026; Prosthetics Eff 11/11/2025; Orthotics Eff 10/1/2025 |
| CPAP/PAP & supplies | not located as standalone MA policy | — |
| Oxygen / respiratory | Home Mechanical Ventilators - MA; Hyperbaric Oxygen Therapy - MA | Home Mech Ventilators Eff 7/1/2025 Rev 6/1/2026; HBOT Eff 5/12/2026 Rev 4/1/2026 |
| Spine surgery / fusion | Spinal Fusion Surgery - MA | Eff 5/1/2026 Rev 4/14/2026 |
| Epidural / facet injections | Injections for Chronic Pain Conditions - MA | Eff 1/13/2026 Rev 2/2/2026 |
| Cataract surgery | not located as standalone MA policy | — |
| Anti-VEGF / intravitreal (Eylea/Avastin) | not located in medical TAD | — |
| Behavioral health / inpatient psych | not located as MA policy (Medicaid behavioral abundant) | — |
| Skin substitutes / CTPs | Skin and Tissue Substitutes - MA | Eff 5/1/2026 Rev 4/14/2026 |
| Oncology / chemotherapy drugs | not located as single medical MA policy (CAR-T & HSCT policies exist) | CAR-T Eff 9/2/2025; HSCT Eff 11/11/2025 |
| Knee / hip arthroplasty | Knee Arthroplasty - MA; Hip Arthroplasty - MA | Knee Eff 10/14/2025 Rev 5/1/2026; Hip Eff 10/14/2025 Rev 1/2/2026 |
| Bariatric surgery | Bariatric Surgery - MA | Eff 1/13/2026 Rev 6/1/2026 |
| Sleep studies | not located as diagnostic-testing MA policy | — |
| Genetic / molecular testing | Genetic Testing for Hereditary Cancer - MA (+ ~15 more genetic/molecular MA policies) | Hereditary Cancer Eff 5/1/2026 Rev 4/14/2026; Inherited Conditions Eff 7/1/2026; Comprehensive Genomic Profiling Eff 4/1/2026 |
| Hospice | not located as MA policy | — |
Humana’s CMS prior-authorization metrics posting →
Denied by Humana? Don’t pay a bill you may not owe.
Appeals win far more often than people expect. See how the deadlines and the process work, or fast-track a rehab/nursing discharge.
Insurer / contract level. Medicare does not publish per-plan denial rates. Rates are 2024 prior-authorization determinations; data as of July 2026. Notes: KFF prose cites 5.8% denial (vs 5.5% chart dataset) - flagged. Lowest overturn after Kaiser. Posting page live, per MA H-contract; metric VALUES JS-rendered, not extractable this pass. Informational only — not medical, legal, or billing advice.