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This form is for practitioners and providers who want to appeal or complain about Aetna's decisions or actions. It requires information about the member, the service, the claim, and the reason for the request.
If you disagree with a claim or utilization review decision, you can submit a dispute online, by phone, or by mail. Find out the timeframe, contact information, and state-specific forms for disputes and appeals.
Download and complete this form to request a review of a claim or service denial by Aetna. You can also call, write, or fax Aetna with your request and provide additional information.
Learn how to request, appeal or complain about your Medicare coverage or care with Aetna. Find forms, deadlines, contact information and online resources for different types of requests and situations.
This form is for your representative's use in making suggestions or filing formal complaints or appeals regarding any aspect of the Aetna Health Plan or any physician, hospital, or other health care professional or health services organization providing your care as an enrollee/member of Aetna.
If Aetna denies your request for coverage of a medical item or service or a Medicare Part B prescription drug, you can appeal within 60 days. Download this form, fill it out, and send it to Aetna by mail, fax, or website.
Member Complaint and Appeal Form. NOTE: Completion of this form is voluntary. To obtain a review, you or your authorized representative may also call our Member Services Department using the telephone number displayed on the member ID card or submit a request in writing to the address listed at the end of your Explanation of Benefits (EOB) or ...
