Aetna Medicare Plans
Aetna Medicare Rx Plan (PDP): Exceptions, Appeals and Grievances
We know it's important to have the coverage you need. That includes coverage of your prescription drugs.
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.
If you have a coverage issue or complaint (grievance) call us at 1-877-238-6211 (TTY:711). Or complete the online Aetna Medicare Advantage Plan or Prescription Drug Plan Grievance Form.
For more info on how we make coverage decisions and handle your appeals and complaints, download and read Medicare Prescription Drug Coverage Determinations, Exceptions, Appeals, and Grievances Information (9 pages, 106 kb).
If you'd like to get an aggregate number of exceptions, appeals and grievances filed with Aetna Medicare, 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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