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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 or 1-877-238-6211 (TTY: 711), seven days a week from 8 a.m. to 8 p.m., local time. 

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 

 

 

You can also file a complaint on Medicare's website

 

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.

       Y0001_M_OT_WB_30760_R5 CMS Approved

       Page last updated: Thu Jun 30 19:29:02 EDT 2016 

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