Appeals

The Appeals Process

Aetna Better Health of Virginia has an Inquiry, Grievance, and Appeals process for members and providers to dispute a claim authorization or an Aetna Better Health decision. This includes both administrative and clinical decisions of Aetna Better Health, including grievances and appeals regarding reasonable accommodations and access to services under the Americans with Disabilities Act. A provider has 60 days (which must be done in writing) and a member has 60 days from the Notice of Action to file an Appeal. A provider has sixty days to file a Grievance and a member can file a grievance at any time. A grievance may be filed in writing or by calling Customer Service. Members have a one-level internal appeal process through Aetna Better Health.

Authorization Release for Standard Appeal

If you are a health care provider, member representative, or a doctor, please fill out the the Authorization Release for Standard Appeal form and fax this form with your appeal.

For more information on the appeals process, refer to Chapter 14 in the Provider Manual.