Coverage Redetermination Form

Coverage Redetermination Form

Because we, Aetna Better Health of Ohio, 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.

Aetna Better Health of Ohio
Part D Appeals, Pharmacy Department
4500 E. Cotton Center Blvd 
Phoenix, AZ 85040

Attn. Redeterminations

Expedited appeal requests can be made by phone at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free. 

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.