8609007995 (2024)

FAQs

How do I appeal my Aetna claim denial? ›

You can file a grievance or appeal using our online grievance and appeal form. 1-855-772-9076 (TTY: 711). You can send a secure fax to Aetna^® grievances and appeals at 959-888-4487. Your doctor can file a grievance or request an appeal on your behalf after you give them your written permission.

Within 180 calendar days of the initial claim decision.

You can fax your complaint or appeal to 1-877-223-4580.

Filing a claim is really that simple. You can also print and mail claims forms to Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079, or Fax to 1-859-455-8650. Claims forms are available for download from the bottom of the screen when you access the member portal or call Member Services.

If an insurance company denies a request or claim for medical treatment, insureds have the right to appeal to the company and also to then ask the Department of Insurance to review the denial. These actions often succeed in obtaining needed medical treatment, so a denial by an insurer is not the final word.

We will start processing your request soon. If you provided your email address, we will send you a confirmation email and status updates about your reimbursem*nt request. It may take up to 30 days from the time we receive all the information until we complete our review.

An appeal often comes after a legal dispute has been resolved. If one of the parties believes that the judge, juries, or lawyers made a mistake that resulted in the wrong court results, they can file an appeal.

Claims rejections occur when the clearinghouse or the payer stops a claim from entering their processing system. This is typically due to missing, incomplete, outdated, or incorrect information included in the claim.

Claim Filing Limits For Aetna

However, exceptions exist for specific services with extended timeframes, so always double-check your contract and specific service guidelines. For non-participating providers, Aetna's standard claim filing deadline is 180 days from the date of service.

What is the timely filing limit for Aetna Better Health of Texas appeal? ›

TIMELY FILING APPEALS

The standard timely filing period for Aetna Better Health of Texas is 95 days, measured from the claim date of service or the paid date of the primary carrier's EOP, whichever is later. Corrected claims must be received within 120 days of the first denial of the service.

Hartford, CT

Aetna / Headquarters

CLAIM.MD | Payer Information | Aetna Affordable Health Choices.

The payer denied 93 percent of the emergency room claims that California investigated, underscoring that surprise billing remains a relevant issue during the coronavirus pandemic.

If a plan requires a referral, the PCP should issue it for all specialist visits, including visits in a hospital clinic. Referrals may be issued for consultation and treatment by using the CPT code 99499. Referrals are valid for 1 year, and the first visit must be used within 90 days.

Appeals are typically reviewed by a separate entity, such as an independent review organization (IRO), that is unbiased and impartial. Reconsiderations, on the other hand, are usually reviewed by the same payer that initially denied the claim.

The appeal letter should be concise, but compelling. It should clearly explain why the treatment or service is necessary for the patient's health, and should address the specific reason for the denial. It's important to use language that is easy to understand, and to provide concrete examples whenever possible.