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Get more help
Questions? Check your provider manual (PDF) for more info about complaints and appeals. Or contact us.
You can also learn about our member complaints and appeals process.
Filing a complaint
Both in-network and out-of-network providers may file verbal complaints with us. We can resolve them outside the formal complaint and appeal process. Provider 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 concern other than an adverse benefit determination
Some provider complaints are subject to the member complaint process. In these cases, we transfer them. These include complaints from a provider on behalf of a member with written consent (except for an expedited request).
Filing an appeal
When you file a claim appeal, you’ll want to be sure it meets these requirements:
- It’s a written request to appeal a claim determination.
- You're asking us to further consider the claim based on the original and/or more info you submit.
- Your appeal document includes the word “appeal.”
You can appeal in writing by completing an appeal form (PDF). Or you can take these steps:
- Submit a copy of the remit/Explanation of Benefits (EOB) page that shows the claim was paid or denied.
- Submit a copy of the remit/EOB for each claim you’re appealing.
- Circle all claims you’re appealing on the remit/EOB page.
- Tell us the reason for the appeal.
- Tell us about any incorrect info and provide the correct info we should use to reconsider the claim.
- Attach a copy of any supporting info that we have asked for. For timely filing, include the acceptance report we sent to your claims clearinghouse. You’ll want to put any supporting info on a separate page — avoid copying it to the other side of the remit/EOB.
- Save a copy of all your documentation.
File a complaint or appeal now
You can file complaints and appeals:
Online
You can file a complaint or appeal in your Provider Portal. Need help with registration? Just contact Availity at 1-800-282-4548. You can get help from 8 AM to 8 PM ET, Monday to Friday.
By email
You can file a complaint or send an appeal form (PDF) by email.
You can also email a complaint to HPM_Complaints@HHSC.State.TX.us.
By mail
You can file a complaint or send an appeal form (PDF) by mail to:
Aetna Better Health® of Texas
ATTN: Complaints and Appeals Department
P.O. Box 81040
5801 Postal Rd.
Cleveland, OH 44181
By fax
You can file a complaint or send an appeal form (PDF) by fax to
1-877-223-4580.
By phone
You can file a complaint or ask about the appeal process by phone. Just contact us.