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Grievances and appeals

We want you to be happy with the care you get from us and our providers. So, if you’re ever unhappy with your plan or a provider, you can file a grievance. And if you’re unhappy with a decision we made, you can file an appeal. 

Help us better serve you

Help us better serve you

grievance is when you’re unhappy with the quality of care or services you received from:

 

  • One of your doctors, like your primary care physician 

  • One of your providers, like a pharmacy or hospital

  • Aetna Better Health® of Illinois 

An appeal is when you want us to review and change a decision we made about your coverage. You’ll get an Adverse Benefit Determination letter from us if a service is reduced, stopped or can’t be approved. Then, you can file an appeal.

File your grievance or appeal here

I want to file a grievance or an appeal

 

We take your concerns seriously. So if you want to file a grievance or appeal, it's important to know the following: 

 

  • There's no time limit for filing a grievance. 

  • You can file an appeal after you receive an Adverse Benefit Determination letter. 

  • You need to file your appeal within 60 days from the date you receive this letter. Or within 10 calendar days of receiving the letter if you want to continue your current treatment.  

  • You can speed up your appeal if waiting 15 calendar days is harmful to your health. 

  • We'll make a decision within 24 hours of receiving your expedited appeal.

 

What happens next?

What happens next?

Grievance

 

We’ll send you a letter after we receive your grievance. Then, we’ll send another letter within 90 days with our decision.

 

Appeal

 

We’ll send you a letter after we receive your appeal. Then, we’ll send another letter within 15 days with our decision. We’ll send our decision in 24 hours if you expedite your appeal.

More options

If you don’t agree with the appeal decision, you can ask for a Medicaid External Independent Review (EIR), a State Fair Hearing or both. An EIR isn’t available for appeals related to services received through the Elderly waiver, the Persons with Disabilities waiver, the Persons with Brain Injury waiver, the Persons with HIV or AIDS waiver or the Supportive Living Facilities waiver.