Aetna: billing error

Collect

• provider bill
• EOB
• member ID card

Steps

1. Compare the provider bill with the EOB in the member account.

   OnlineSearch claims and EOBs (member login) Sign-in required

2. Call Member Services to ask about a claim processed wrongly. Ask the provider to rebill to the EOB amount.

   PhoneCorporate contact center (members should call the number on the ID card) +1-800-872-3862

3. If it is not fixed, file a complaint or appeal online.

   FormMember complaint, grievance and appeal form (non-Medicare plans)

Rules in force

• No Surprises Act (surprise billing protections and good faith estimates)
  45 CFR part 149 (including 149.420 and 149.610)

  Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.

  Source: cms.gov, verified 2026-10-12

  3 citable points

  • Deadline

    Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.

    Source: law.cornell.edu, verified 2026-10-12

  • Deadline

    Patient-provider dispute resolution is available when the provider charged "$400 or more" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a "$25 non-refundable administrative fee".

    Source: cms.gov, verified 2026-10-12

  • Policy

    While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.

    Source: cms.gov, verified 2026-10-12

• Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements
  15 U.S.C. 8401-8405

  A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.

  Source: law.cornell.edu, verified 2026-10-12

  1 citable point

  • Policy

    The seller must obtain "a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account".

    Source: law.cornell.edu, verified 2026-10-12

If that fails, escalate

Go up one step at a time. Keep the reference numbers and dates from each contact.

1. Customer service

   PhoneCorporate contact center (members should call the number on the ID card) +1-800-872-3862

   Use the number on the back of the member ID card.

2. Written complaint

   FormMember complaint, grievance and appeal form (non-Medicare plans)

   Internal appeal or grievance. Medicare plans use the Medicare appeal addresses.

3. State agency

   Your state’s insurance department. Find it in the list of state agencies (also as JSON: states/<code>.json, for example states/ny.json).

   External review for fully insured plans; complaint to the state where the plan is issued.

4. Federal regulator

   RegulatorU.S. Department of Labor, Employee Benefits Security Administration +1-866-444-3272

   Employer self-funded (ERISA) plans. Aetna's own External Review Program covers self-funded plans whose sponsor elects it.

5. Federal regulator

   RegulatorCMS No Surprises Help Desk +1-800-985-3059

   Surprise bills under the No Surprises Act.

Watch out

Related

• Billing error at other companies
• How Aetna complaints actually go (dossier, checked 2026-10-12)
• Health insurance — how complaints work
• Aetna: insurance claim denied
• Aetna: surprise medical bill