Medicare Advantage Appeals

Aetna Medicare Advantage: Appeals and Grievances

We understand the importance of having the coverage you need. If you have a coverage issue or problem, please contact Member Services at the phone number on the back of your Aetna Medicare ID card, and they will help you resolve it. If you feel that Aetna Medicare should pay for benefits and services that aren't covered, you have the right to appeal any decision. You have two options: 

• File an appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive. Complete the electronic Medicare Advantage Appeals form. 
• For grievances to address your complaints or problems, you may contact our Member Services Department at the number on the back of your member ID card or complete the online grievance form. Complete the electronic grievances form. 

For more complete information about the various Aetna Medicare appeals processes, download Medicare Advantage Coverage Determinations, Appeals and Grievances Y0001_M_OT_WB_10925_R1 CMS Approved 12/29/2011 (9 pages, 102kb). 

You can find Medicare Contact Information in the Help and Resources section of this website. Paper versions of the Appeals and Grievances Forms are also found in the Help and Resources section at the bottom of the Other Forms and Documents tab. 

If you'd like to speak with the Office of the Medicare Ombudsman (OMO) for help with a complaint, grievance, or information request, visit the website of the Ombudsman on Medicare.gov.