Humana Behavioral Health Appeals in Virginia
Appealing a Humana behavioral health denial in Virginia means tracking two separate clocks: Humana's own 30-day Level-1 appeal window, and Virginia's 40-day prompt-payment statute (Va. Code § 38.2-3407.15) for clean-claim payment. This guide covers both, plus Humana's filing address and Virginia's parity protections.
Where to file your Humana appeal
P.O. Box 14601
Lexington, KY 40512
Virginia's prompt-payment window
In Virginia, state-regulated (fully-insured) plans — including many Humana plans — generally must pay or formally respond to a clean claim within 40 calendar days under Va. Code § 38.2-3407.15. This deadline does not bind self-funded ERISA plans. This is a claim-payment deadline, not the appeal-decision deadline. If Humana missed this window on your claim, cite it as a separate payment violation alongside your Humana appeal — not as the deadline for the appeal decision itself.
Carrier provider contracts must require the carrier to pay a claim within 40 days of receipt, except where the claim is not clean or is submitted fraudulently (Va. Code § 38.2-3407.15(B)(1)). Within 30 days of receipt the carrier must notify the submitter of any defect that prevents a clean claim (§ 38.2-3407.15(B)(2)). This is a claim-payment standard, not an appeal-decision deadline.
MHPAEA parity for Humana in Virginia
Federal MHPAEA (29 USC § 1185a; 29 CFR § 2590.712) applies to Humana's group health plans operating in Virginia. The CAA 2021 § 203 disclosure duty requires Humana to produce its NQTL comparative analysis on request.
Humana's parity posture: Federal MHPAEA parity does not apply to Humana Medicare Advantage plans — the parity argument on this page applies only to Humana commercial/ERISA plans. Humana administers behavioral health through an internal BH team. Strong Medicare Advantage presence — MA plans follow Medicare appeals rules (42 CFR § 422), which differ from commercial ERISA rules.
State-level parity laws may add further protections in Virginia — check with the state's Department of Insurance for current guidance.
Common Humana denial codes
Virginia's insurance commissioner
If your internal Humana appeal is denied, Virginia's Department of Insurance can help with a complaint or external review for fully-insured plans. Look up the official contact via the NAIC consumer locator.
Note: self-funded ERISA plans are generally exempt from state insurance regulation. If your patient's Humana plan is employer-sponsored and self-funded, your remedies run through the U.S. Department of Labor (EBSA) rather than Virginia's commissioner.
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Generate my appeal letter →Frequently asked questions
How long does Humana have to respond to an appeal in Virginia?
Humana generally has 30 calendar days to respond to a Level-1 appeal. Separately, Virginia's prompt-payment statute gives payers 40 days to respond to a clean claim (Va. Code § 38.2-3407.15) — a different deadline governing claim payment, not the appeal decision.
Does MHPAEA apply to Humana in Virginia?
Generally, yes — for Humana's group health plans. Federal MHPAEA (29 CFR § 2590.712) applies to Humana's group health plans in Virginia. Request Humana's NQTL comparative analysis under CAA 2021 § 203.
Where do I mail or fax a Humana appeal?
Mail to Humana Medical Appeals, P.O. Box 14601, Lexington, KY 40512. You can also fax to 1-800-832-4651. This address is the same nationally, including for Virginia providers.