Complaints, Grievances & Appeals
You have the right to file a suggestion, complaint or grievance about Aetna, your plan, or a health care service, provider or professional.
Use the Appeal, Formal Complaint or Suggestion Form to send your comments to Aetna.
Get help from your state
Your state insurance office can help you if you don’t agree with a decision made by your health plan or if you decide to appeal a decision.
- Choose the state you live in if your medical plan is self-funded.
- Choose the contract state if your medical plan is insured.
If you are not sure, ask your employer or call the toll-free number on the back of your medical plan ID card to find out which type of plan you have.
Get help from the federal government
The Health Care Reform law includes rules about appeals. Many plans have to follow these rules. If your plan is covered by the law*, you can contact the Employee Benefits Security Administration for help at 1-866-444-EBSA (3272).
Living outside the United States?
You may have a medical plan that covers you or your family while you’re living outside the United States. If it's subject to the U.S. health care reform law, choose the state where the plan sponsor has its main place of business. Call the toll-free number on the back of your medical plan ID card if you're not sure.
Alabama
Alabama Department of Insurance
Consumer Services
P.O. Box 303351
Montgomery, AL 36130-3351
334-241-4141
Insdept@insurance.alabama.gov
http://www.aldoi.gov/ContactUs.aspx
Alaska
Alaska Division of Insurance
P. O. Box 110805
Juneau, AK 99811-0805
800-467-8725
http://www.commerce.state.ak.us/ins/Insurance/consumer.html
American Samoa
American Samoa Department of Insurance
Office of the Governor
American Samoa Government
Pago Pago, American Samoa 96799
684-633-4116
Fax: 684-633-2269
Arizona
Arizona Department of Insurance
Consumer Services
2910 N. 44th Street, Ste. 210
Phoenix, AZ 85018-7269
800-325-2548
602-364-2499 (Phoenix)
602-364-2977 (Spanish)
http://www.id.state.az.us/
consumers@azinsurance.gov
Arkansas
Consumer Assistance Program:
Arkansas Insurance Department
Consumer Services Division
1200 West Third St.
Little Rock, AR 72201
855-332-2227
Insurance.consumers@arkansas.gov
Arkansas Department of Insurance - for insured plans only
Same mailing address as above
800-282-9134
http://insurance.arkansas.gov/
California
Consumer Assistance Program:
California Department of Managed Health Care and Department of Insurance
980 9th Street, Suite #500
Sacramento, CA 95814
888-466-2219
http://www.HealthHelp.ca.gov
California Department of Insurance - for insured plans only
California Department of Insurance
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
800-927-4357
http://www.insurance.ca.gov/
California processes:
- CA DMO Dental GRIEVANCE FORM
- CA DMO Dental GRIEVANCE FORM - Spanish California HMO/DMO GRIEVANCE FORM - California residents can use this electronic form to file an HMO or DMO grievance, appeal, or complaint. Printable versions (in PDF format) of this grievance form are available in:
- English
- Spanish
Colorado
Department of Regulatory Agencies
Colorado Division of Insurance
1560 Broadway, Suite 850
Denver, CO 80202
800-930-3745
303-894-7490
http://www.dora.state.co.us/insurance
insurance@dora.state.co.us
Connecticut
Connecticut Department of Insurance
153 Market Street
Hartford, CT 06103
800-203-3447
http://www.ct.gov/cid/cwp/view.asp?a=1272&Q=480608
Delaware
Insurance Commissioner and Department of Insurance
841 Silver Lake Blvd.
Dover, DE 19904
302-674-7300
consumer@state.de.us
http://www.delawareinsurance.gov/
District of Columbia (DC)
Consumer Assistance Program:
District of Columbia Healthcare Finance
Office of the Ombudsman
441 4th St., NW (9th and 10th Fl.)
Washington, DC 20001
877-685-6391
healthcareombudsman@dc.gov
http://ombudsman.dc.gov
District of Columbia Department of Insurance - for insured plans only
810 First Street
NE, Suite 701
Washington, DC 20002
202-727-8000
disb@dc.gov
Florida
Florida Department of Financial Services
Division of Consumer Services
200 East Gaines Street
Tallahassee, FL 32399-4288
877-693-5236
http://www.myfloridacfo.com/consumers/needourhelp.htm
Georgia
Georgia Office of Insurance and Safety Fire Commissioner
Customer Services Division
2 Martin Luther King, Jr. Drive
West Tower, Suite 716
Atlanta, GA 30334
800-656-2298
http://www.oci.ga.gov/consumerservice/home.aspx
Guam
Guam Department of Insurance
Dept. of Revenue & Taxation
Taxpayer Services Division
P.O. Box 23607
GMF, Guam 96921
Fax: 671-633-2643
pinadm@revtax.gov.gu
https://www.guamtax.com
Hawaii
Hawaii Department of Commerce and Consumer Affairs
Hawaii Insurance Division
Health Insurance Branch
P. O. Box 3614
Honolulu, HI 96811
808-586-2790
808-586-2799
http://hawaii.gov/dcca/ins/
Idaho
Idaho Department of Insurance
P.O. Box 83720
Boise, ID 83720-0043
800-721-3272
208-334-4250
http://www.doi.idaho.gov
Illinois
Consumer Assistance Program:
Illinois Department of Insurance
100 Randolph St., 9th Floor
Chicago, IL 60601
877-527-9431
http://www.insurance.illinois.gov
Illinois Department of Insurance - for insured plans only
320 W. Washington St
Springfield, IL 62727
866-445-5364
http://www.insurance.illinois.gov
Indiana
Indiana Department of Insurance
311 W. Washington Street, Suite 100
Indianapolis, IN 46204
800-622-4461
idoi@idoi.in.gov
http://www.in.gov/idoi/
Iowa
Iowa State Insurance Division
Consumer Advocate Bureau
330 Maple Street
Des Moines, Iowa 50319
515-281-5705
877-955-1212
http://insuranceca.iowa.gov/
consumer.advocate@iid.iowa.gov
Kansas
Consumer Assistance Program:
Kansas Insurance Department
Consumer Assistance Division
420 SW 9th Street
Topeka, KS 66612
800-432-2484 (in state)
785-296-7829 (all others)
http://www.ksinsurance.org
CAP@ksinsurance.org
Kansas Department of Insurance - for insured plans only
Same address as above
785-296-3071
commissioner@ksinsurance.org
Kentucky
Kentucky Health Insurance Advocate
Department of Insurance
P.O. Box 517
Frankfort, KY 40602-0517
877-587-7222
http://healthinsurancehelp.ky.gov
DOI.CAPOmbudsman@ky.gov
Louisiana
Louisiana Department of Insurance
Office of Health Insurance
P.O. Box 94214
Baton Rouge, LA 70804
225-219-4770
800-259-5301
http://www.ldi.louisiana.gov/
Maine
Consumer Assistance Program:
Maine Consumer Assistance Program
Consumers for Affordable Healthcare
12 Church Street
Augusta, ME 04338
800-965-7476
http://www.mainecahc.org
consumerhealth@mainecahc.org
Maine Department of Insurance - for insured plans only
Department of Professional & Financial Regulation
Bureau of Insurance
#34 State House Station
Augusta, ME 04333-0034
800-300-5000 (toll free in Maine)
207-624-8475
Insurance.PFR@maine.gov
Marshall Islands
A list of consumer assistance resources for residents of this territory is not available.
Maryland
Consumer Assistance Program:
Maryland Office of the Attorney General
Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202
877-261-8807
http://www.oag.state.md.us/Consumer/HEAU.htm
heau@oag.state.md.us
Maryland Department of Insurance - for insured plans only
Maryland Insurance Administration
200 Saint Paul Place, Suite 2700
Baltimore, MD 21202
800-492-6116
http://www.mdinsurance.state.md.us
Massachusetts
Massachusetts Division of Insurance
Customer Services Division
1000 Washington Street, Suite 810
Boston, MA 02118-6200
877-563-4467
http://www.mass.gov/doi
Michigan
Consumer Assistance Program:
Michigan Department of Insurance and Financial Services
HICAP
611 W. Ottawa Street
Lansing, MI 48933
877-999-6442
http://www.michigan.gov/HICAP
Michigan Department of Insurance - for insured plans only
DIFS
P. O. Box 30220
Lansing MI 48909-7720
877-999-6442
difs-info@michigan.gov
The Federated States of Micronesia
A list of consumer assistance resources for residents of this territory is not available.
Minnesota
Minnesota Department of Commerce (for fully insured plans)
85 7th Place East, Suite 500
St. Paul, MN 55101
651-296-2488
800-657-3602
http://www.state.mn.us/portal/mn/jsp/home.do?agency=Insurance
Mississippi
Consumer Assistance Program:
Health Help Mississippi
800 North President Street
Jackson, MS 39202
877-314-3843
http://www.healthhelpms.org
healthhelpms@mhap.org
Mississippi Department of Insurance - for insured plans only
P.O. Box 79
Jackson, MS 39205-0079
800-562-2957 (Consumers Only)
http://www.mid.ms.gov/
Missouri
Consumer Assistance Program:
Missouri Department of Insurance
301 W. High Street, Room 830
Jefferson City, MO 65101
800-726-7390
http://www.insurance.mo.gov
consumeraffairs@insurance.mo.gov
Missouri Department of Insurance - for insured plans only
P. O. Box 690
Jefferson City, MO 65102-0690
573-751-4126
http://insurance.mo.gov/
Montana
Montana Commissioner of Securities and Insurance
840 Helena Avenue
Helena, MT 59601
In-state only: 800-332-6148
406-444-2040
http://www.csi.mt.gov/consumers/consumers.asp
Nebraska
State Department of Insurance
Nebraska Department of Insurance
P. O. Box 82089
Lincoln, NE 68501-2089
877-564-7323
800-833-7352
http://www.doi.ne.gov
Nevada
Nevada Division of Insurance
2501 East Sahara Ave., Suite 302
Las Vegas, Nevada 89104
702-486-4009
http://doi.nv.gov/Consumers/
New Hampshire
New Hampshire State Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
800-852-3416
http://www.nh.gov/insurance/
Email to: consumerservices@ins.nh.gov
New Jersey
New Jersey State Insurance Department
Office of Consumer Protection Services
NJ Department of Banking and Insurance
P.O. Box 329
Trenton, NJ 08625-0329
609-292-7272
Consumer Hotline: 800-446-7467
http://www.state.nj.us/dobi/consumer.htm
New Mexico
Consumer Assistance Program:
New México Consumer Assistance Program
P. O. Box 1689
Santa Fe, NM 87504-1689
855-427-5674
http://www.OSI.state.nm.us (website)
mchb.grievance@state.nm.us (email)
New Mexico Department of Insurance – for insured plans only
Office of Superintendent of Insurance
PO Box 1689
Santa Fe, NM 87504-1689
855-427-5674
http://www.osi.state.nm.us/
New York
Department of Financial Services
One State Street
New York, NY 10004-1511
800-342-3736
http://www.dfs.ny.gov/consumer/chealth.htm
North Carolina
Consumer Assistance Program:
Health Insurance Smart NC
North Carolina Department of Insurance
430 N. Salisbury Street
Suite 1018
Raleigh, NC 27603
877-885-0231
http://www.ncdoi.com/Smart/
North Carolina Department of Insurance – for insured plans only
Services for Consumers
1201 Mail Service Center
Raleigh NC 27699-1201
800-546-5664
http://www.ncdoi.com/
North Dakota
North Dakota Insurance Department
State Capitol, fifth floor
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
701-328-2440
800-247-0560
http://www.nd.gov/ndins/
insurance@nd.gov
Northern Mariana Islands
Consumer Assistance Program:
Department of Commerce
Caller Box 10007 CK
2nd Floor
Saipan, MP 96950
670-644-3005
http://cnmicap.wordpress.com
North Marianas Department of Insurance – for insured plans only
CNMI Department of Commerce
Caller box 10007
Saipan , MP 96950
670-644-3000
info@commerce.gov.mp
Ohio
Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, OH 43215
800-686-1526
http://www.insurance.ohio.gov/Pages
life.health.mcd@insurance.ohio.gov
Oklahoma
Oklahoma Insurance Department
Five Corporate Plaza
3625 NW 56th, STE 100
Oklahoma City, OK 73112
405-521-2991
http://www.ok.gov/oid/Consumers/Consumer_Assistance/index.html
Oregon
Oregon Division of Insurance
350 Winter St NE
Salem, OR 97309-0405
888-877-4894
http://www.insurance.oregon.gov/consumer/health-insurance/health.html
Palau
A list of consumer assistance resources for residents of this territory is not available.
Pennsylvania
Consumer Assistance Program
Pennsylvania Department of Insurance
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA 17111
877-881-6388
http://www.pahealthoptions.com
Pennsylvania Department of Insurance Consumer Services – for insured plans only
Pennsylvania Insurance Department
Same as above
717-787-2317
http://www.insurance.pa.gov
Puerto Rico
Puerto Rico Department of Insurance
Office of the Commissioner of Insurance
B5 Calle Tabonuco Suite 216, PMB 356
Guaynabo, PR 00968-3029
787-304-8686
Fax: 787-273-6082
http://www.ocs.gobierno.pr/ocspr/
www.planmedicogarantizado.com
Rhode Island
Office of the Health Insurance Commissioner
1511 Pontiac Ave, Building #69 first floor
Cranston, RI 02920
410-462-9517
http://www.ohic.ri.gov/
South Carolina
South Carolina Department of Insurance
P. O. Box 100105
Columbia, SC 29202
800-768-3467
803-737-6180
consumers@doi.sc.gov
South Dakota
South Dakota Division of Insurance
445 East Capitol Avenue
Pierre, SD 57501
605-773-3563
http://www.state.sd.us/drr2/reg/insurance
insurance@state.sd.us
Tennessee
Tennessee Department of Commerce and Insurance
Consumer Insurance Services
500 James Robertson Parkway, 4th Floor
Nashville, Tennessee 37243
800-342-4029
615-741-2218
Fax: 615-532-7389
Texas
Texas Department of Insurance
333 Guadalupe
Austin, TX 78701
800-578-4677
http://www.tdi.texas.gov/index.html
Utah
Utah Insurance Department
State Office Building, Room 3110
Salt Lake City, UT 84114
801-538-3077
http://www.insurance.utah.gov
health.uid@utah.gov
Vermont
Vermont Division of Financial Regulation
89 Main Street
Montpelier, VT 05620-3101
802-828-3301
http://www.dfr.vermont.gov/insurance/health-insurance/health-insurance
Virginia
Virginia State Corporation Commission
Bureau of Insurance
Tyler Building, 1300 East Main Street
Richmond, Virginia 23219
800-552-7945 (Virginia only)
804-371-9741
http://www.scc.virginia.gov/boi/index.aspx
Bureauofinsurance@scc.virginia.gov
Virgin Islands
Consumer Assistance Program:
U.S. Virgin Islands Division of Banking and Insurance
1131 King Street, Suite 101
Christiansted, St. Croix, VI 00820
340-773-6459
http://ltg.gov.vi
Virgin Islands Department of Insurance – for insured plans only
St. Croix
Office of the Lieutenant Governor
Same as above
St. Thomas
Office of the Lieutenant Governor
#18 Kongens Gade
St. Thomas, Virgin Islands 00802
Administration (STT) 340-774-7166
Administration (STX) 340-773-6459
http://ltg.gov.vi/
Washington
Washington State Office of the Insurance Commissioner
5000 Capitol Blvd., SE
Tumwater, WA 98501
800-562-6900
360-725-7080
http://www.insurance.wa.gov
cap@oic.wa.gov
West Virginia
West Virginia Department of Insurance
P. O. Box 50540
Charleston, WV 25305-0540
304-558-3386
888-879-9842
Wisconsin
Wisconsin Office of the Commissioner of Insurance
125 South Webster Street
Madison, WI 53703
800-236-8517
http://oci.wi.gov/consinfo.htm
ocicomplaints@wisconsin.gov
Wyoming
Wyoming Insurance Department
106 East 6th Avenue
Cheyenne, WY 82002
307-777-7401
800-438-5768 (within WY)
http://insurance.state.wy.us/
wyinsdep@state.wy.us
* This generally applies to most Medical plans effective or renewed on or after September 23, 2010.
This generally does not apply to:
- Dental-only plans
- Vision-only plans
- Retiree-only plans
- Medicare Advantage plans
- Medicare Part D plans
- Medicare Supplement plans
