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 electronically.

You may also mail or Fax your information by printing the following form: 
Member Complaint and Appeal Form

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

Arkansas Insurance Department
Consumer Services Division
1200 West Third St.
Little Rock, AR 72201
855-332-2227
Insurance.consumers@arkansas.gov

California
Consumer Assistance Program: (applies to HMO based plans only)

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 and process description are available in : 

CA GRIEVANCE FORM and Process Description - English

CA GRIEVANCE FORM and Process Description - 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
Email: insurance@dora.state.co.us

Connecticut
Consumer Assistance Program

State of Connecticut Office of the Health Care Advocate
153 Market Street
Hartford, CT 06144
866-486-4446
www.ct.gov/oha

Connecticut Department of Insurance - for insured plans only
Connecticut Insurance Department
Consumer Affairs
153 Market Street
P.O. Box 816
Hartford, CT 06142
800-203-3447
Email: cid.ca@ct.gov

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
http://ombudsman.dc.gov
Email: healthcareombudsman@dc.gov

District of Columbia Department of Insurance - for insured plans only
810 First Street
NE, Suite 701
Washington, DC 20002
202-727-8000
Email: 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/division/consumers/needourhelp.htm#.U6yCMZTIZps

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:

Office of Consumer Health Insurance
Consumer Services Section 
Chicago Office
122 S. Michigan Ave., 19th Floor
Chicago, IL 60603

Springfield Office
320 W. Washington
Springfield, IL 62767
877-527-9431
http://www.insurance.illinois.gov

Illinois Department of Insurance - for insured plans only
Chicago Office
122 S. Michigan Ave. 19th Floor
Chicago, IL 60603

Springfield Office
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

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

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 Health Insurance Consumer Assistance Program (MHICAP)
P.O. Box 2490
12 Church Street
Augusta, ME 04338
800-965-7476
http://www.mainecahc.org

Maine Department of Insurance - for insured plans only
Bureau of Insurance
#34 State House Station
Augusta, ME 04333-0034
800-300-5000 (toll free in Maine)
207-624-8475
Email: 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
Consumer Assistance Program:

Massachusetts Consumer Assistance Program
One Federal Street
Boston, MA 02110
800-272-4232
http://www.massconsumerassistance.org

Massachusetts Department of Insurance - for insured plans only
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
Email: difs-HICAP@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

Minnesota Department of Health (for state-regulated HMO)
Managed Care Systems Section
P.O. Box 64882
St. Paul, Minnesota 55164-0882
(651) 201-5178
http://www.health.state.mn.us/index.html

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

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 472
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
 
Email: mchb.grievance@state.nm.us

New Mexico Department of Insurance – for insured plans only
Office of Superintendent of Insurance
Consumer Assistance Bureau
PO Box 1689
Santa Fe, NM 87504-1689
855-427-5674
http://www.osi.state.nm.us/
Email: osi.consumer@state.nm.us

New York
Consumer Assistance Program:

Community Health Advocates
Community Service Society of New York
105 East 22ND Street 
New York, NY 10010
888-614-5400
http://www.communityhealthadvocates.org

New York Department of Insurance - for insured plans only
Department of Financial Services

Consumer Assistance Unit
One Commerce Plaza
Albany, NY 12257
800-342-3736
http://www.dfs.ny.gov/consumer/chealth.htm
Email:
http://www.dfs.ny.gov/insurance/nyins_csb.htm

North Carolina
Consumer Assistance Program:

Health Insurance Smart NC
North Carolina Department of Insurance
430 N. Salisbury Street
Suite 1018
Raleigh, NC 27603
855-408-1212

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
855-408-1212
http://www.ncdoi.com/Consumer

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

Department of Commerce
Caller Box 10007 CK
2nd Floor
Saipan, MP 96950
670-644-3005
http://cnmicap.wordpress.com

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/default.aspx
Email: 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

Pennsylvania Department of Insurance
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA 17111
877-881-6388
http://www.pahealthoptions.com

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
Consumer Assistance Program:

Vermont Consumer Assistance
Vermont Legal Aid
264 North Winooski Ave
Burlington, VT 05402
800-889-2047
www.vtlegalaid.org

Vermont Department of Insurance - for insured plans only
State of Vermont
Department of Financial Regulation

89 Main Street
Montpelier, VT 05620-3101
802-828-3301
http://www.dfr.vermont.gov

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

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

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/connect-with-us/contact-us/consumers/

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
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