Coverage Redetermination Form

Because we, Aetna Better Health FIDA Plan, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.

Fill out the Coverage Re Determination Form online. Alternatively, you can download or request a paper copy of this form and send it us by mail or fax.

Mail
Aetna Better Health FIDA Plan
55 West 125th Street, Suite 1300 
New York, NY 10027

Fax
Attn. Redeterminations
1-855-264-3822   

Expedited appeal requests can be made by phone at 1-855-494-9945. For hearing impaired, call 711.

Who may make a request: Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.