Find out about your rights as an Aetna member, how Aetna makes coverage decisions, resources to use when making health decisions, and other information targeted to you as an Aetna member.

Contacting Member Services
Use this form to contact Member Services to get answers to questions about claims and benefits. Also use this form to recommend changes to our policies or services.  more

Review of Denied Claims
Aetna's goal is to help members get proper care for their conditions. But Aetna does not pay for every type of care that is requested. When we do not pay for a service, it is called a denied claim. If you receive a denied claim, you may be eligible for a review by independent doctors, called an external review.  more

Advance Directives
Learn about living wills and advance directives. These documents allow you to explain in detail what type of medical treatment you want, or don't want, when an illness or accident makes it impossible for you to make decisions.  more

Member Rights and Responsibilities Statement
Learn about your rights and responsibilities as an Aetna HMO, PPO or Medicare member.  more

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Patient Safety Information
Here you will find a variety of resources to improve your health care safety.  more

Understanding Coverage Decisions
Find out about Aetna's guidelines and policies. Aetna uses these policies to make decisions about your health coverage. Keep in mind that actual coverage decisions are made on a case-by-case basis by Aetna.  more

Quality Report Cards
Use these report cards to evaluate health plans.

Physician-Specific Cost and Quality Information
You can now get price information for office visits, diagnostic services and more, as well as information about clinical quality, for doctors in certain geographic areas. Looking at this information before you visit your doctor can help you get the most value for your health care dollars. Price, clinical quality and efficiency information is available for doctors in Connecticut; Washington, D.C.; Northern Virginia; Maryland; Cincinnati, Cleveland, Columbus, Dayton and Springfield, Ohio; Northern Kentucky; Southeast Indiana; and South Florida. Price information only is available for doctors in Kansas City, Kansas and Missouri; Las Vegas, Nevada and Pittsburgh, Pennsylvania.  more

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Quality Improvement Information
As an Aetna member, you are entitled to information about Aetna's programs to improve health care quality. To learn more about quality efforts under way in your local area, call the Member Services phone number listed on your member ID card. Ask Member Services for the phone number of your regional Quality Management office.

For information about Aetna Behavioral Health's efforts to improve quality, ask for the phone number of your Care Management Center Quality Management office.

Utilization Management
Aetna reviews many of the services used by patients, including tests, treatments, surgeries and hospital stays both to help make appropriate coverage decisions and to help members get appropriate care. We use nationally recognized guidelines to decide whether a service is appropriate, and, therefore covered. If we do not consider the service to be needed, we do not pay for it.  more

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New Technology Assessment
Aetna reviews new medical technologies and services to decide if our health plans should cover them. We also review existing tests, procedures and treatments to see if they can be used in new ways and to determine the appropriate policies for paying claims.

Steps in evaluating new medical technologies include:

• Studying research and evidence on safety and effectiveness and talking to experts
• Examining guidelines from medical and government groups, including the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS)
• Determining whether new tests, procedures and treatments are experimental or investigational

Aetna's policies about specific medical technologies are described in Clinical Policy Bulletins.  more

Non-discrimination statement
Aetna does not discriminate in providing access to health care services on the basis of race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age or national origin. Federal law mandates that Aetna comply with Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, the Americans with Disabilities Act, other laws applicable to recipients of federal funds, and all other applicable laws and rules.

Statement on Incentives
Aetna's goal is to help members get proper care for their conditions. But Aetna does not pay for every type of care that is requested. When we do not pay for a service, it is called a denied claim. We make decisions about what to pay for based on the members' health plan and generally accepted guidelines. Members can always protest a denied claim. We do not reward employees or anyone else for denying a claim. In fact, we make known the risks of not providing proper care.

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