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

 

 


       Y0001_4006_10829 Approved 10/27/2017
       Page last updated: Wed Aug 12 14:19:29 UTC 2020