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Questions?
Just check your provider manual (PDF) for answers about appeals and complaints. Or contact us.
Filing a complaint
Both in-network and out-of-network providers may file verbal complaints with us. We can resolve them outside the formal appeals and complaints process. Your complaints could be based on things like:
- Policies and procedures
- One of our decisions
- A disagreement about whether a service, supply or procedure is a covered benefit, is medically necessary or is done in the appropriate setting
- Any other issue of concern
Some provider complaints are subject to the member process. In these cases, we transfer them. These include complaints that you may file on behalf of a member.
Filing an appeal
Both in-network and out-of-network providers have the right to appeal our claims determinations within 60 calendar days of receipt of the claim denial.
You can file an appeal if:
- We denied reimbursement for a medical procedure or item you provided for a member due to lack of medical necessity or no prior authorization (PA) when it was required
- You have a claim that has been denied or paid differently than you expected and wasn’t resolved to your satisfaction through the dispute process
File an appeal or complaint now
You can file an appeal or complaint:
Online
You can file an appeal or complaint in your Provider Portal. Need help with registration? Just contact Availity at 1-800-282-4548. You can get help from 8 AM to 8 PM ET, Monday to Friday.
By email
You can email us your appeal or complaint.
By mail
You can send your appeal or complaint to:
Aetna Better Health® of New York
Appeals & Complaints
PO Box 81040
5801 Postal Rd
Cleveland, OH 44181
Reviews of appeals and complaints
Clinical appeal and complaint reviews are completed by health professionals who:
- Hold an active, unrestricted license to practice medicine or in a health profession
- Are board certified (if applicable)
- Are in the same profession or in a similar specialty as normally manages the condition, procedure or treatment concerned in the case
- Are neither the same reviewer that made the original decision nor someone who reports to that person
Member appeals and complaints overview
When members ask, we help them complete appeal and complaint forms and take other steps.