Medicare Advantage Appeals
Aetna Medicare Advantage Plan (HMO) (PPO): Exceptions, 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.
For more info on how we make Aetna Medicare Advantage plan coverage decisions and handle your appeals and complaints, download and read Aetna Medicare Advantage Coverage Decisions, Appeals and Grievances (9 pages, 102 kb).
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.
- For more info on how we make prescription drug coverage decisions and handle your appeals and complaints, download and read Aetna Medicare Prescription Drug Coverage Determinations, Exceptions, Appeals, and Grievances Information (9 pages, 106 kb).
If you'd like to get an aggregate number of appeals and grievances 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 exception, 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.
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