Skip to main content

Coverage Decisions, Appeals and Grievances

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

Learn more about the ombudsman

 

 

 

      GRP_13_384 (11/14)
      Page last updated: May 28, 2020

You are now leaving the Aetna Medicare website.

The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, please click 'Close.'

Close Continue
You are now leaving our Medicare website.

You are leaving our Medicare website and going to our non-Medicare website. If you do not intend to leave our site, please click 'Close.'

Close Continue