Is your provider filing on your behalf? If yes, be sure they use this address, not the provider address.
The name of the person you want to represent you. 
Your member ID number from your ID card. If you write a letter, tell us that you want someone else to act for you to file a grievance or appeal. For state fair hearings, you can write a letter to the Division of Administrative Law and include it with your state fair hearing request. If you need the form, call us at 1-85 (TTY: 711). For appeals, you can write a letter or fill out the personal appeal representative (PAR) form (PDF). For grievances, you can write a letter. You have to give written permission to the person, allowing them to act for you. They can also act for you in a state fair hearing. This person is your member representative. You can have someone else file a grievance or appeal for you. Within 72 hours: We’ll let you know our decision in this amount of time if your appeal was for urgent or emergency care, you’re in the hospital or your provider says that waiting up to 30 days for a decision could be harmful to your health. You can also ask for more time if you need it. If we extend the time, we’ll send you a letter to explain the delay. Up to 14 days: We may extend the decision time about your appeal if we need more info and the delay is in your interest. The decision letter will tell you what we’ll do and why. Within 30 calendar days (standard): We’ll let you know our decision on your appeal in writing. Before or within 10 days from the date on our Adverse Benefit Determination letter: You need to file your appeal if you want your services to continue while we review your appeal. 
Within 60 calendar days from the date on our Adverse Benefit Determination letter: You or your representative need to file your appeal.
Aetna timely filing for appeals how to#
We’ll let you know if we need more info and how to provide it.
Within 5 business days: We’ll send you a letter saying we received your appeal. Not approving a service for you because it was not in our network. Not giving you the service in a timely manner. Not paying for a service your PCP or other provider requested. Stopping a service that was approved before. Not approving a service your provider asked for. You’d like us to review the decision to be sure we were correct about things like: Then, if you like, you can file an appeal. We call this a Notice of Adverse Benefit Determination. You’ll get a letter from us if we deny, stop, hold or reduce an ongoing service or treatment you’ve been receiving. This means you disagree with a decision we made about your coverage for services your provider believes are medically necessary. And we’ll do our best to answer your questions and resolve your issue. Your provider or a plan staff member wasn’t sensitive to your cultural needs or other special needs you may have.ĭo you have a grievance? Filing a grievance or appeal won’t affect your health care services or benefits coverage. You had trouble getting an appointment with your provider in a reasonable amount of time. Your provider or a plan staff member was rude to you or didn’t respect your rights. You were unhappy with the quality of care or treatment you received. Here are some things you may file a grievance about: One of your providers (for example, vision or dental services providers) You’re unhappy with the quality of care or services you received from: Mental health member handbook: Spanish (PDF). Mental health member handbook: English (PDF).
0 kommentar(er)
