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Coverage decisions, appeals and grievances

Process for Medicare coverage requests, appeals & complaints

Let us know if you have a concern about your coverage or care. Call us at the number on your member ID card to discuss your concern.

 

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

 

  • Ask for coverage of a medical service. In some cases, we may allow exceptions for a service that is normally not covered.

  • File an appeal if we deny your request. 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.

 

There are different steps to take, based on the type of request you have. 

 

You can contact Medicare

You can contact the Medicare Beneficiary Ombudsman (MBO) for help with a complaint, grievance or information request.

 

We're here to help

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