Aetna

In short

Call the number on your member ID card, then appeal a denied claim within 180 days. Aetna's decision clock depends on whether your plan has one or two appeal levels, and urgent appeals are decided within 72 or 36 hours. After the internal appeal, ask for external review: through the state for insured plans, or through Aetna's External Review Program for some self-funded employer plans. Your state insurance office (in California, the DMHC for insured HMOs and the Department of Insurance for insured traditional plans) can help if you disagree with a decision. Report billing for care you never got to Aetna's fraud hotline, 1-800-338-6361.

How complaints actually go

• Members should call the number on the member ID card; Aetna's corporate contact center is 1-800-872-3862 (Monday-Friday, 8 a.m.-6 p.m. ET), and its mailing address is Aetna Inc., 151 Farmington Avenue, Hartford, CT 06156. Contact Aetna
• Non-Medicare members can file a complaint online or on a printable form; Medicare members use a separate grievance process. Aetna complaints, grievances and appeals
• Non-Medicare appeals: 180 days from the denial notice (longer if the plan documents allow). One-appeal plans decide pre-service appeals within 30 days and others within 60 days; two-appeal plans decide within 15 and 30 days, and the second review must be requested within 60 days of the first decision. Aetna claim denials
• Urgent appeals are decided within 72 hours (one-appeal plans) or 36 hours (two-appeal plans). Aetna claim denials
• Medicare Advantage: expedited authorization appeals within 72 hours, standard authorization appeals within 30 calendar days, standard claim-denial appeals within 60 calendar days with no expedited option, and standard Part D redeterminations within 7 days. Aetna Medicare appeals

What tends to work

• Include the group name, your name, your member ID and the records you want reviewed with the appeal. Aetna claim denials
• If your employer's self-funded plan has opted into the Aetna External Review Program, a denial for lack of medical necessity or as experimental that would cost you more than $500 can go to an independent reviewer after appeals; reviews are generally decided within 30 calendar days and bind Aetna and the plan. Call the National External Review Unit at 1-877-848-5855. Aetna External Review Program
• Ask the state for help: Aetna says your state insurance office can help if you disagree with a plan decision, and for plans under federal health reform the Employee Benefits Security Administration (1-866-444-3272) can help with an appeal. Aetna complaints, grievances and appeals
• Appeal Medicare Advantage post-acute denials: CVS Health (Aetna's parent) overturned 98.2 percent of appealed denials for skilled nursing facility admission in June 2024. HHS OIG OEI-09-24-00331, June 2026

Traps and fine print

• In California, the right regulator depends on the plan: the Department of Managed Health Care for insured HMO and DMO plans, the Department of Insurance for insured traditional plans. Aetna complaints, grievances and appeals
• The Aetna External Review Program applies only when the self-funded plan sponsor elects it and the plan appeal process is exhausted. Aetna External Review Program
• Expedited decisions are not available for Medicare Advantage claim-denial appeals, only for authorizations. Aetna Medicare appeals

By the numbers

• Medicare Advantage, June 2024: CVS Health denied 13.5 percent of skilled nursing facility admission requests (2,170 denials) and overturned 375 of 382 appealed denials. HHS OIG OEI-09-24-00331, June 2026
• In Medicaid managed care, CVS overturned 22 percent of appealed prior authorization denials in 2025 data. KFF, August 2026

Scams that target customers

• Check every plan statement; billing for services or supplies never provided is fraud. Call the number on your ID card, the fraud hotline at 1-800-338-6361, or email AetnaSIU@aetna.com. Aetna fraud and abuse
• "Free" genetic tests and cheek swabs offered by phone, at events or door to door are used to steal Medicare information; refuse kits your doctor did not order. HHS OIG genetic testing alert
• Medicare will never call to sell you anything or visit your home; give your Medicare number only to your doctor, your insurer or others who should have it. Medicare.gov: reporting fraud and abuse