Allina Health | Aetna is an affiliate of Allina Health and Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Allina Health | Aetna.
We want to be your first stop if you have a concern about your coverage or care. So, if you do, please call us at the number on your member ID card.
As an Allina Health | Aetna Medicare member, you have the right to:
There are different steps to take based on the type of request you have.
How to ask for medical coverage or request an appeal for a service
If you have a Medicare Advantage plan and you're requesting a medical service, you'll ask for a coverage decision (organization determination). If you receive a denial and are requesting an appeal, you'll "request a medical appeal"
You can call us, fax or mail your information.
Call: ${membersPhone} ${tty}, Monday to Friday, 8 AM to 8 PM.
Fax: 1-866-759-4415
Mail: Allina Health Aetna Medicare
PO Box 7405
London, KY 40742
We'll get back to you within:
If we don't cover or pay for your medical benefits or services, you can appeal our decision.
If we don't cover or pay for your medical benefits or services (Medicare Part C), you can appeal our decision. To do so, submit the online form, or fax or mail your request to us.
Submit an authorization appeal online
Submit a claim denial appeal online
Print an authorization appeal form
Print an authorization appeal form - Español
Print an authorization appeal form - 中文
Print a claim denial appeal form
Print a claim denial appeal form - Español
Print a claim denial appeal form - 中文
Fax: 1-724-741-4953
Mail: Allina Health | Aetna Medicare Part C Appeals
PO Box 14067
Lexington, KY 40512
An expedited appeal can only be requested for a service that has not been completed.
If you or your doctor believe the standard review timeframe could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If you do not obtain your doctor's support for an expedited appeal, we will decide if your case requires a fast decision. A claim denial is not eligible for an expedited (fast) decision.
If you need a faster (expedited) decision, you can call or fax us.
We’ll get back to you within:
You can contact the Medicare Beneficiary Ombudsman (MBO) for help with a complaint, grievance or information request.
How to ask for prescription drug coverage or request an appeal
If you're requesting coverage of a medication under your Medicare Advantage plan, or if you’re asking for advance approval to fill a prescription, you'll ask for a coverage decision or exception request (determination).
Your doctor can call us at 1-800-414-2386 ${tty}, 7 days a week, 8 AM to 8 PM, to request drug coverage. Or your doctor can fax a completed, signed form with a statement of medical necessity to 1-800-408-2386.
Prescription Drug Prior Authorization and Exception Request Forms for Prescribers
You or your appointed representative can call us at 1-800-414-2386 ${tty}, 7 days a week, 8 AM to 8 PM, to request drug coverage.
If you prefer, you can print and complete the appropriate forms below. Forms can be sent to us in one of three ways:
1. By fax: 1-800-408-2386
2. By mail:
Allina Health | Aetna Medicare
Coverage Determinations
P.O. Box 7773
London, KY 40742
3. You can also request coverage online.
Print our drug coverage determination request form
Print the hospice drug coverage request under Part D form
You'll leave Allina Health | Aetna Medicare and go to the CMS website if you select the link below.
Print the Medicare program drug coverage determination request form
We’ll get back to you within 72 hours (24 hours if you request a faster decision).
If your request is denied, you can file an appeal.
If we deny your prescription drug request, you can appeal our decision. You can file your standard or expedited appeal using one of the below:
Online:
Mail:
Allina Health | Aetna Medicare Part D Appeals and Grievances
PO Box 14579
Lexington, KY 40512
Download our appeals form – Spanish
You'll leave Allina Health | Aetna Medicare and go to the CMS website if you select the link below.
Download the Medicare program appeals form
Fax: 1-724-741-4954
Phone: 1-833-620-8809 ${tty}, 7 days a week, 24 hours a day
We’ll get back to you within 7 days (72 hours if you request a faster decision).
Inpatient hospital discharge
During your inpatient hospital stay you’ll get a notice called “An Important Message from Medicare about Your Rights”. You’ll have to sign it to show that you understand your rights as a hospital patient, including:
You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting:
You’ll receive a "Notice of Medicare Non-Coverage (NOMNC)" in writing at least 2 days before we decide it’s time to stop covering your care. When your coverage for that care ends, we'll stop paying our share of the cost for your care. You can ask to change this decision so you're able to continue coverage.
You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care.
The Quality Improvement Organization will respond to you within 48 hours after receiving your request.
You may ask for this review immediately but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal.
The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review.
You can file a complaint about the quality of care or other services you get from us or from a Medicare provider.
You can fax or mail us your complaint. You can download our form or use your own paper. Be sure to sign your complaint and use the fax number or address shown on the form.
You can also submit your complaint online.
To send a complaint to Medicare, complete the Medicare Electronic Complaint form.
We’ll get back to you within 30 days (24 hours if you request a faster response).
If you have questions about the status of your request or complaint, call us.
If you'd like to get a total for the number of appeals, grievances and exceptions filed with Allina Health | Aetna Medicare, call us at ${membersPhone} ${tty}, ${membersHours}.
Allina Health | Aetna is an affiliate of Allina Health and Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Allina Health | Aetna.
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