Medicare Information

Medicare PPO for nonpar providers

Increased membership projected in our Aetna Medicare Plan (PPO)

We are projecting an increase in membership in our Medicare Advantage (MA) PPO plans on a national basis. Our MA PPO plan members have the flexibility of seeing either nonparticipating or participating providers who are eligible to receive payment from Medicare. Several large employers have already signed on to cover their Medicare-eligible retirees under these MA PPO plans. As a result, you may see an increase in patients with Aetna Medicare Plan (PPO) coverage.  Learn more  (PDF, 1.1 MB).

Aetna has a formal process for Medicare Advantage Plan provider dispute resolution for non-contracted providers. Learn more  (PDF, 70 KB) about Medicare Advantage Plan provider dispute resolution.

Aetna Practitioner/Provider Appeal Process 

Health care professionals and organizational health care providers can dispute adverse decisions. The information below explains when and how to submit a dispute. It applies to all our medical benefits plans. (Please note that state requirements take precedence when they differ from our policy.)

Aetna has a formal process that allows participating and non-participating dentists to file an appeal. Learn more about Aetna's Provider Appeal Process.

Aetna has a formal process for Medicare Advantage Plan provider payment dispute resolution for non-contracted providers.  (PDF, 70 KB)

Aetna has a formal process for Aetna has a formal process for Medicare Advantage Plan provider payment appeal resolution for non-contracted providers..  (PDF, 137 KB)

Additional Information
More online resources are available on Aetna's secure website for physicians, hospitals and health care professionals. Once logged in, choose “Doing Business with Aetna,” then “Aetna Benefit Products,” followed by “Aetna Medicare.”

Find Member information on www.aetnamedicare.com.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies. The Aetna companies that offer, underwrite, or administer benefits coverage include Aetna Life Insurance Company.