If you are an existing Aetna member in the State of New York or a consumer in the State of New York who may be interested in becoming an Aetna member and need additional information on a specific clinical issue, you may request Clinical Review Criteria by submitting the form at the bottom of this page.

Submit request for Clinical Review Criteria

Or you may submit a written request. Your written request must contain the following information:

• Name
• Address
• Telephone number
• Request for clinical review criteria which Aetna would utilize in making a coverage determination involving a specific condition

You may send your written request via US Mail to the following address:

Aetna
Attn: CRC Requests
1800 E Interstate Ave
Bismarck, ND 58503

If the member still has questions or needs further assistance after reviewing the CPB page, they should contact Member Services at the number listed on their ID card.

Although Clinical Review Criteria may be used by prospective enrollees to assist in making health plan enrollment decisions, it does not constitute medical advice. Clinical Review Criteria can be highly technical and consumers should review this information with their treating physicians. Coverage decisions are made based on the member’s individual benefit plan and consider the individual situation in applying the Clinical Review Criteria.

All fields marked with a RED asterisk (*) are required in order to proceed.