Medicare Advantage Appeals
Aetna Medicare Advantage Plan (HMO) (PPO): Appeals and Grievances
We know it's important to have the coverage you need
If we don't cover or pay for your benefits or services, you can appeal our decision. Just complete the online Request for an Appeal of an Aetna Medicare Advantage (Part C) Plan Denial.
If you have a coverage issue or complaint (grievance), call us at 1-800-282-5366 (TTY: 711), 8 a.m. to 8 p.m. local time, seven days a week. Or complete the online Aetna Medicare Advantage Plan or Prescription Drug Plan Grievance Form.
Have an Aetna Medicare Advantage plan that includes prescription drug coverage (MAPD) and need to request coverage for your drug under Part D?
- If we don't currently cover your medication, you can ask us to make an exception. Just complete the online Request for Prescription Drug Coverage Determination Form.
- If we deny your request, you can appeal our decision. Simply complete an online Request for Redetermination for an Aetna Medicare Prescription Drug Denial.
Need more information?
Learn how we make coverage decisions and handle your appeals and complaints. Download and read Medicare prescription drug coverage decisions, exceptions, appeals, and grievances.
If you'd like to get an aggregate number of appeals, grievances and exceptions filed with Aetna Medicare, call us at 1-800-282-5366 (TTY: 711), from 8 a.m. to 8 p.m., local time, seven days a week.
If you have questions about the status of your appeal or grievance, call us at 1-877-238-6211 (TTY: 711), from 8 a.m. to 8 p.m., local time, seven days a week.
You can find your plan's Summary of Benefits along with Medicare contact information in the Help and Resources section of this website. Downloadable versions of the above forms are also available in this section.
You can contact the Office of the Medicare Ombudsman (OMO) for help with a complaint, grievance, or information request. To learn more, go to the Website of the Ombudsman at: http://www.cms.gov/Center/Special-Topic/Ombudsman-Center.html?redirect=/center/ombudsman.asp.
If you prefer to file a grievance through Medicare, click on the following link: Medicare Electronic Complaint Form.
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