Humana Denied Your Mental Health Treatment?
Humana Inc. denies 14.2% of claims on average. But 56% of appeals succeed when patients fight back. Your mental health treatment denial may have grounds for a successful appeal.
Why Humana Denies Mental Health Treatment
Session limits or visit caps
Not medically necessary per reviewer assessment
Provider not in-network
Diagnosis not covered under plan
Humana's Common Denial Tactics
Incorrect CPT/ICD coding as basis for denial
Claiming services duplicate prior treatments
Denying rehabilitation services as "not improving"
How to Win Your Mental Health Treatment Appeal
Cite MHPAEA — mental health must be covered at parity with medical/surgical
Document treatment necessity from psychiatrist or psychologist
Show that denial applies stricter criteria than comparable medical treatment
File with DOL if ERISA plan violates parity requirements
Laws That Protect You
Mental Health Parity and Addiction Equity Act (MHPAEA)
ACA Essential Health Benefits — Mental health is required
State mental health parity laws
Tips for Appealing to Humana
Verify CPT and ICD-10 codes match the services rendered
Get your provider to document functional improvement goals
For Medicare Advantage, cite CMS guidelines on coverage determination
Ready to Fight Your Mental Health Treatment Denial?
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.