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 ${anCompany} Medicare member, you have the right to:
There are different steps to take based on the type of request you have.
If you have a Medicare Advantage plan and you’re requesting a medical service, you’ll ask for a coverage decision (organization determination).
You can call us, fax or mail your information.
Call: 1-800-245-1206 (TTY: 711), ${hours}.
Fax: 1-859-455-8650
Mail: Aetna Medicare Precertification Unit
P.O. Box 14079
Lexington, KY 40512-4079
When you’ll hear back
We’ll get back to you within:
If we don't cover or pay for your medical benefits or services, you can appeal our decision.
If we don't cover or pay for your medical benefits or services (Medicare Part C), you can appeal our decision. Submit the online form, fax or mail your request to us.
Submit an authorization appeal online
Submit a claim denial appeal online
Fax: 1-724-741-4953
Mail: Aetna Medicare Part C Appeals & Grievances
PO Box 14067
Lexington, KY 40512
If you need a faster (expedited) decision, you can call or fax us.
To send a complaint to Medicare, complete the Medicare Electronic Complaint form.
When you’ll hear back
We’ll get back to you within:
Your doctor can call us at 1-800-414-2386 (TTY: 711), 7 days a week, 24 hours a day, to request drug coverage. Or your doctor can fax a completed, signed form with a statement of medical necessity to 1-800-408-2386.
Prescription Drug Prior Authorization & Exception Request Forms for Prescribers
You or your appointed representative can call us at 1-800-414-2386 (TTY: 711) to request drug coverage.
If you prefer, you can print and complete the appropriate forms below. Forms can be sent to us in one of three ways:
1. By fax: 1-800-408-2386
2. By mail:
Aetna Medicare Coverage Determinations
P.O. Box 7773
London, KY 40742
3. You can also request coverage online.
If we deny your prescription drug request, you can appeal our decision. You can file your standard or expedited appeal using one of the below:
Online:
Mail: ${company} Medicare Part D Appeals & Grievances
PO Box 14579
Lexington, KY 40512
Fax: 1-724-741-4954
To send a complaint to Medicare, complete the Medicare Electronic Complaint form.
When you'll hear back
We’ll get back to you within 7 days (72 hours if you request a faster decision).
During your inpatient hospital stay you’ll get a notice called “An Important Message from Medicare about Your Rights”. You’ll have to sign it to show that you understand your rights as a hospital patient, including:
You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting:
You’ll receive a "Notice of Medicare Non-Coverage (NOMNC)" in writing at least 2 days before we decide it’s time to stop covering your care. When your coverage for that care ends, we'll stop paying our share of the cost for your care. You can ask to change this decision so you're able to continue coverage.
You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care.
If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to us instead.
Within 48 hours the reviewers will tell you their decision.
You may ask for this review immediately, but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal.
The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review.
You can file a complaint about the quality of care or other services you get from us or from a Medicare provider.
You can also submit your complaint online.
You can fax or mail us your complaint. You can download our form or use your own paper. Be sure to sign your complaint and use the fax number or address shown on the form.
To send a complaint to Medicare, complete the Medicare Electronic Complaint form.
When you'll hear back
We’ll get back to you within 30 days (24 hours if you request a faster response).
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