ByHow To File Aetna Complaints and Get Your Voice Heard
Aetna is an American managed health care company, providing health insurance and related services to over 22.5 million people. It was founded in 1853 and is based in Hartford, Connecticut.
The company began participating in Medicare with the passage of the Patient Protection and Affordable Care Act in 2010, as well as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
In 2018 the United States Department of Justice filed a lawsuit against Aetna for unlawfully denying users' insurance claims. The jury has awarded $25.5 million to the family of the cancer patient who was denied coverage by the company.
Aetna has also been accused of retroactively denying people's insurance policies—a process known as "health rescission.”
Following the acquisition of Humana Inc. in July 2018, Aetna was ordered to pay $17 million to a cancer patient who was denied coverage for a heart condition.
In April 2018, the state of New Mexico sued Aetna for unlawful practice of denying Medicaid recipients access to expensive prescribed medications. Aetna has also been criticized by Medicare for overcharging the government approximately $12 million in Medicare overpayments in 2007 and 2009.
All things considered, Aetna isn't the most reliable health care insurance provider. Insurers have reported countless problems with the company, from denying benefits to delaying payments.
If you've run into issues with your insurance claim, this article will show you how to file a complaint against the company and, if necessary, send demand letters to Aetna in small claims court.
You may also want to consult with a lawyer about your rights and remedies if you've been wronged by the health insurance company.
How To Submit Complaints About Aetna Health Insurance
If you have complaints against Aetna health insurance, a provider, your plan, or the company's services, you can contact the Aetna provider complaints department at 1-800-872-3862.
The phone support is available every day from 8:00 a.m. to 6:00 p.m. ET. The waiting times are reportedly very slow, so you'll likely have to wait for more than 15 minutes to connect to a customer support representative,
Contacting the company via email is a better option—you don't have to waste time, and it's easier to explain all of the details of your complaint in writing. You can send your email complaint to contact@aetna.com. The company typically responds to emails within one business day.
There is also an option to file a Non-Medicare complaint using the online form on Aetna's website. You can also print out the complaint form, fill it out, and mail or fax it to the company:
- Mail: Aetna, PO Box 14463, Lexington, Kentucky
- Fax: 859-425-3379CRTM
Aetna usually responds to complaints within 30 days, so look for an acknowledgment letter within that period.
When opening a complaint, be sure to mention the reason you are filing the complaint against the company—and pick one. It needs to be crystal clear what happened and why it may be a violation of your rights as a consumer.
If possible, include medical records, which will enable Aetna to better evaluate your case and possibly find evidence that proves whether or not your healthcare experience was satisfactory.
If you believe that the company has failed to deliver the promised services or has otherwise discriminated against you, you can also file Aetna insurance complaints with a Civil Rights Coordinator. You can find all of the instructions and the appeal form here.
| How To File Complaints About Aetna | |
|---|---|
| Online Form | https://www.aetna.com/individuals-families/member-rights-resources/complaints-grievances-appeals.html |
| contact@aetna.com | |
| Aetna, PO Box 14463, Lexington, Kentucky | |
| FAx | 859-425-3379CRTM |
Aetna Medicare Complaints
Medicare beneficiaries are advised to contact Aetna with their complaint by calling the phone number on their member ID card.
As an Aetna member, you have the right to file a complaint about services provided by the company or file an appeal if your request for coverage was denied.
Depending on the type of request you have and the decision you're appealing, there are different steps in the process. You can find all the details on this page.
You can also use this online form to file a complaint regarding Aetna’s Medicare advantage plan or prescription drug plan.
Aetna Insurance Complaints Being Ignored? Start a Small Claims Court Lawsuit
If you're unhappy with how your insurance claim was handled, you can file a lawsuit against Aetna in small claims court.
You can file the claim with your local small claims court clerk's office. Some small claims courts also provide online forms for filing claims.
The processes may vary depending on the state and county you live in, so it's best to consult the court's website or call the court clerk's office to ensure you have all the required documents ready.
The court costs are typically $20, although you have to pay more if your claim involves more than $2,500 in damages.
Before the case can reach trial, you have to send Aetna a demand letter, detailing the reason for the lawsuit and giving them an opportunity to settle the matter outside of court by reimbursing you for the damages incurred.
The demand letter must include:
- Your name, address, and contact information
- Amount in damages, including statutory damages or punitive damages if applicable
- Full name and corporate address of the defendant (Aetna Inc., Hartford, Connecticut, United States)
- A brief explanation of the circumstances that lead to your lawsuit
- The settlement amount you're seeking from the defendant
Once Aetna has received the demand letter, it will have 20 days to respond. If Aetna fails to respond to your demand within 20 days or refuses to pay the damages you are seeking, you'll have an opportunity to present your case in front of a judge.
If they rule in your favor, you could be awarded a portion of the damages you've incurred.
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If Aetna ignores your complaint or refuses to give you the compensation, we will help you escalate matters and send demand letters to them in small claims court.
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