Complaints, Grievances & Appeals
Aetna Better Health will try its best to deal with your concerns or issues as quickly as possible and to your satisfaction. But if we do not, you have actions you can take. You may use our grievance process or our appeals process, depending on what kind of problem you have.
There will be no change in your services or the way you are treated by Aetna Better Health staff or a health care provider because you file a grievance or an appeal. We will maintain your privacy and give you any help you may need to file a grievance or appeal. This includes providing you with interpreter services or help if you have vision and/or hearing problems or want additional help. You may also choose someone (like a relative or friend or provider) to act for you.
To file a grievance or to appeal a plan action, please call 1-855-456-9126 or write to:
Aetna Better Health of New York
PO Box 81139,
5801 Postal Road
Cleveland, OH 44181
When you contact us, you will need to give us your name, address, telephone number and the details of the problem.
What is a grievance?
When you tell us about your dissatisfaction about the care and treatment you receive from our staff or providers of covered services, it’s called a grievance. For example, if someone was rude to you or you do not like the quality of care or services you have received from us, you can file a grievance with us.
The grievance process
You may file a grievance orally or in writing with us. The person who receives your grievance will record it, and the right plan staff will oversee the review of the grievance. We will send you a letter telling you that we received your grievance and give you a description of our review process. We will review your grievance and give you a written answer within one of the following timeframes:
- If a delay would significantly increase the risk to your health, we will decide within 48 hours after we receive the necessary information.
- For all other types of grievances, we will notify you of our decision within 45 days of receiving the necessary information, but the process must be completed within 60 days of the receipt of the grievance. The review period can be increased up to 14 days if you request it or if we need more information and the delay is in your interest.
Our answer will describe what we found when we reviewed your grievance and our decision about your grievance.
How do I appeal a grievance?
If you are not satisfied with the decision we make concerning your grievance, you may request a second review of your issue by filing a grievance appeal. You must file a grievance appeal in writing within 60 business days of receipt of our initial decision about your grievance. Once we have reviewed your appeal, we will send you a letter telling you the name, address and telephone number of the individual we have assigned to respond to your appeal. All grievance appeals will be conducted by appropriate professionals. For example, health care professionals who were not involved in the initial decision will handle grievances involving clinical matters.
For standard appeals, we will make the appeal decision within 30 business days after we receive all necessary information. If a delay in making our decision would significantly increase the risk to your health, we will use the expedited grievance appeal process. For expedited grievance appeals, we will make our appeal decision within 2 business days of receipt of necessary information. For both standard and expedited grievance appeals, we will provide you with written notice of our decision. The notice will include the detailed reasons for our decision and, in cases involving clinical matters, the clinical rationale for our decision.
Complaints to New York State
At any time, you may contact the New York State Department of Health to file a complaint.
NYS Department of Health
Bureau of Managed Long Term Care
Complaint Unit Room 1911
Corning Tower ESP
Albany, NY 12237-0062