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Filing a complaint
Both in-network and out-of-network providers may file verbal complaints with us. You must file within 90 days of the dispute resolution or when you became aware of the issue. We can resolve complaints outside the formal complaints and appeals process. Your complaints could be based on things like:
Policies and procedures
One of our decisions
A disagreement about whether a service, supply or procedure is a covered benefit, is medically necessary or is done in the appropriate setting
Any other issue of concern
Some provider complaints are subject to the member process. In these cases, we transfer them. These include complaints and grievances that you may file on behalf of a member.
Filing an appeal
Both in-network and out-of-network providers have the right to appeal our claims determinations within 60 calendar days of receipt of the claim denial.
You can file an appeal if:
- We denied reimbursement for a medical procedure or item you provided for a member due to lack of medical necessity or no prior authorization (PA) when it was required
- You have a claim that has been denied or paid differently than you expected and wasn’t resolved to your satisfaction through the dispute process
To learn more about claims adjustment or reconsideration, just visit our claims page.
File a complaint or appeal now
You can file a complaint or appeal:
You can fax your complaint or appeal to 860-607-7894.
You can send your complaint or appeal to:
Aetna Better Health of Florida
PO Box 81040
5801 Postal Road
Cleveland, OH 44181
Reviews of complaints and appeals
Clinical complaints and appeals reviews are completed by health professionals who:
- Hold an active, unrestricted license to practice medicine or in a health profession
- Are board certified (if applicable)
- Are in the same profession or in a similar specialty as normally manages the condition, procedure or treatment concerned in the case
- Are neither the same reviewer that made the original decision nor someone who reports to that person