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Grievances & Appeals

Process for Medicare coverage requests, appeals & complaints

We want to be your first stop if you have a concern about your coverage or care. Call us at the number on your member ID card. 

As an Aetna Medicare member, you have the right to:

  • Ask for coverage of a medical service or prescription drug. In some cases, we may allow exceptions for a service or drug that is normally not covered. 
  • File an appeal if your request is denied. An appeal is a formal way of asking us to review and change a coverage decision we made.  
  • File a complaint about the quality of care or other services you get from us or from a Medicare provider.
  • Appoint someone else to act on your behalf. 
    How to appoint a representative
There are different steps to take based on the type of request you have.
 

Choose a topic to help us find the right process for you 

 

 

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. 

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Aetna Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: Suburban NY and TX; and Rural ME, NY, UT and WY. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.

       Y0001_4006_8294 Approved 11/04/2016

       Page last updated: Oct 20, 2016

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