Member Information
You are entitled to request a review (appeal) of this benefit determination either by phone or in writing if you do not agree. To request an appeal by phone, you or your authorized representative should call the Member Services phone number listed on your member enrollment card. To request an appeal in writing, you or your authorized representative should submit a written request to the Aetna Health Inc. address listed below. Your request for review must be mailed or delivered within 180 days following receipt of this notice, or such longer period as may be specified in your plan brochure or Summary Plan Description. Your request should include the group name (e.g., your employer), your name, member identification/Social Security number and other identifying information, and the comments, documents, records and other information you would like to have considered. You may also request access to documents relevant to your claim by calling the Member Services phone number listed on your member enrollment card.

Pre-Service Claim
If your claim is a Pre-Service Claim (one for which a benefit must be approved before the receipt of medical care), you will receive notice of a determination within 15 days following receipt of your request. For other claims, you will receive notice of a determination within 30 days following receipt of your request. In either case, if you do not agree with such determination you have the right to file a second request for review. To initiate this process, you must submit a request by calling or writing to Aetna within 60 days from the date that you receive the appeal determination letter.

Urgent Care Claim
If your claim is an Urgent Care Claim (one where delay in making a decision could seriously jeopardize your life, health or ability to regain maximum function, or could subject you to severe pain in the opinion of your physician), you or a physician on your behalf may request an expedited appeal by calling 1-888-408-7485 or by faxing your request to Aetna Expedited Appeals at 1-860-754-0068. You will be notified of a decision not later than 36 hours after receipt of your request for review.

To Submit a Written Appeal Request
To request an appeal in writing, you or your authorized representative should submit a written request to Aetna. To obtain the address, call the 800 number on your Member ID Card, and a customer service representative will be able to give you the address.