Report Incorrect Information

Report Incorrect Information

Please use this web form to report any new or updated information you have discovered regarding any of the specific doctors, hospitals or facilities currently displayed on Aetna's on-line provider directory. Typically, this information includes changes to office phone numbers, addresses, and other demographic information.

^*Required

Please provide the following information:

Your Last Name*

This field must be atleast one character long

Your First Name*

This field must be atleast one character long

Your Email Address*

i.e. example@sample.comThis field must be atleast one character long

Provider Information

Provider Last Name*

Provider First Name*

Type*

Medical Dental Behavioral Health OtherThis field must be atleast one character long

Correction Type*

Address Incorrect	Deceased/retired
Doctor indicates he/she no longer accepts Aetna Insurance	Duplicate listing
Gender Incorrect	Hospital Affiliation incorrect
Language spoken incorrect/missing	No longer accepts new patients
Phone Incorrect	Provider/group name incorrect
Practitioner does not schedule appointments at service location listed	Specialty Incorrect
Please select atleast one check box

Phone Number(Enter 10 digit for phone number and 3 digit area code)

Last Known Address

Address

City

Zip/Postal Code*(Enter 5 digit for Zip/Postal code)

This field must be atleast one character long

State*

This field must be atleast one character long

Important! Please check this form carefully before clicking on the "Submit" button. Some browsers will not keep your information, and you will have to re-type your feedback.