Form for Filing an Appeal, Formal Complaint or Suggestion

This form is for your representative's use in making suggestions or filing formal complaints or appeals regarding any aspect of the Aetna Health Plan or any physician, hospital, or other health care professional or health services organization providing your care as an enrollee/member of Aetna.  The Plan is required by law to respond to your complaints or appeals, and a detailed procedure exists for resolving these situations.
Grievance
Grievance
"Aetna" is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies.  The Aetna companies that offer, underwrite or administer benefit coverage include Aetna Better Health Inc., Aetna Health Inc., Aetna Health of California Inc., Aetna Dental Inc., Aetna Dental of California Inc., Missouri Care, Incorporated, Aetna Health Insurance Company of New York, and Aetna Health Insurance Company and/or Aetna Life Insurance Company.  Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.