Box 14067 lexington, ky 40512 telephone: Please follow timely processing requirements. Aetna is the brand name used for products and services provided by one or more of the aetna group of companies, including aetna life insurance company and its. Web because aetna medicare 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. Web plan type member’s group number (optional) medical dental member’s first name member’s last name member’s birthdate (mm/dd/yyyy) to help us review and. % change approved status effective date aetna life. Standard appeal help ensure appeals and medical records go to the correct place. If you want another individual. Completion of this form is voluntary. You may mail your request to:
There are two kinds of medicare member. Make sure to include any information. (this information may be found on the front of the member’s id card.) today’s date member’s id number plan type member’s group. Web complaint and appeal form. Box 14067 lexington, ky 40512 telephone: You must complete this form. Web all appeals must be submitted in writing, using the aetna provider complaint and appeal form. These changes do not affect member appeals. You can send a secure fax to aetna® grievances and appeals at 959. Your prescriber may file a reconsideration request on your behalf. Web find forms and applications for health care professionals and patients, all in one place.
