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Complaints, Grievances & Appeals

How to file a suggestion, complaint or grievance

You have the right to file a suggestion, complaint or grievance about:

  • Aetna
  • Your plan
  • A health care service, provider or professional

Use our online form to file a complaint or grievance (non-Medicare)

How to file Aetna Medicare complaints and grievances

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*, contact the Employee Benefits Security Administration (EBSA) at 1-866-444-EBSA (3272) for help with an appeal.

Learn more about the EBSA

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
email: Insdept@insurance.alabama.gov
http://www.aldoi.gov/ContactUs.aspx

Last modified 02/03/2016

Alaska

Alaska Division of Insurance
P. O. Box 110805
Juneau, AK 99811-0805
907-465-2515
800-467-8725
https://www.commerce.alaska.gov/web/ConsumerServices.aspx

Last modified 02/04/2016

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

Last modified 02/03/2016

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/
email: consumers@azinsurance.gov

Last modified 02/04/2016

Arkansas

Arkansas Insurance Department
1200 West Third St.
Little Rock, AR 72201
501-371-2640 (local)
800-852-5494
http://insurance.arkansas.gov
email: insurance.consumers@arkansas.gov

Last modified 02/04/2016

 

California
California Processes
California HMO/DMO Grievance Form - Online

Use this online form to submit a complaint, grievance, or appeal. For DMO and HMO members.

DMO and HMO ONLINE GRIEVANCE FORM

DMO Grievance Forms - Printable

View and print these forms to submit a DMO complaing, appeal or grievance: 

CA DMO Dental GRIEVANCE FORM

CA DMO Dental GRIEVANCE FORM - Spanish

HMO Grievance Forms - Printable

View and print these forms to submit an HMO complaint, appeal or grievance. 

CA HMO GRIEVANCE FORM and Process Description - English

CA HMO GRIEVANCE FORM and Process Description - Spanish

The HMO complaint & appeal process

Use this PDF to learn more about your rights regarding complaints and appeals. For HMO members. 

California HMO complaint and appeal process

 
California Consumer Assistance Program: (applies to HMO 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

300 Capital Mall, Suite 1700
Sacramento, CA 95815
916-492-3500 
http://www.insurance.ca.gov 
email: https://interactive.web.insurance.ca.gov/contactCSD/ContactUs.jsp

Last updated 02/10/2016

 

Colorado

Department of Regulatory Agencies
Colorado Division of Insurance
1560 Broadway, Suite 850
Denver, CO 80202
800-930-3745
303-894-7499
http://www.dora.state.co.us/insurance
email: insurance@dora.state.co.us

Last modified 02/04/2016

Connecticut
Consumer Assistance Program

State of Connecticut Office of the Health Care Advocate
153 Market Street
Hartford, CT 06144
866-466-4446
www.ct.gov/oha

Connecticut Department of Insurance - for insured plans only
Connecticut Insurance Department
P.O. Box 816
Hartford, CT 06142-0816
860-297-3800
email: cid.ca@ct.gov
http://www.ct.gov/cid/site/default.asp

Last modified 02/11/2016

Delaware

Insurance Commissioner and Department of Insurance
841 Silver Lake Blvd.
Dover, DE 19904
302-674-7300
email: consumer@state.de.us
http://www.delawareinsurance.gov/

Last modified 02/04/2016

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
Government of the District of Columbia
Department of Insurance, Securities, and Banking
810 First Street
NE, Suite 701
Washington, DC 20002
202-727-8000
http://disb.dc.gov
email: disb@dc.gov

Last modified 02/12/2016

Florida

Florida Department of Financial Services
Division of Consumer Services
200 East Gaines Street
Tallahassee, FL 32399-4288
877-693-5236
850-413-3089 (Out of State)
800-640-0866 (TDD)
http://www.floir.com/Office/SearchableTools.aspx

Last modified 02/05/2016

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

Last modified 02/05/2016

Guam

Guam Department of Insurance
Dept. of Revenue & Taxation
Taxpayer Services Division
P.O. Box 23607
GMF, Guam 96921
Fax: 671-633-2643
email: pinadm@revtax.gov.gu
https://www.guamtax.com

Last modified 02/03/2016

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/

Last modified 02/05/2016

Idaho

Idaho Department of Insurance
P.O. Box 83720
Boise, ID 83720-0043
800-721-3272
208-334-4250
http://www.doi.idaho.gov

Last modified 02/02/2016

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 St.
Springfield, IL 62767
877-527-9431
http://insurance.illinois.gov

Illinois Department of Insurance - for insured plans only
Chicago Office
122 S. Michigan Ave. 19th Floor
Chicago, IL 60603
312-814-2420

Springfield Office
320 W. Washington St
Springfield, IL 62727
866-445-5364
http://insurance.illinois.gov

Last modified 02/11/2016

Indiana

Indiana Department of Insurance
311 W. Washington Street, Suite 100
Indianapolis, IN 46204
800-622-4461
email: consumerservices@idoi.in.gov
http://www.in.gov

Last modified 02/02/2016

Iowa

Iowa State Insurance Division
Consumer Advocate Bureau
601 Locust St. 4th fl. 
Des Moines, Iowa 50309
515-281-5705
877-955-1212
http://insuranceca.iowa.gov/
email: insurance@iid.iowa.gov

Last modified 02/11/2016

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

Last modified 02/11/2016

Kentucky

Kentucky Health Insurance Advocate
Department of Insurance
P.O. Box 517
Frankfort, KY 40602-0517
877-587-7222
800-648-6056 (TYY)
http://healthinsurancehelp.ky.gov
email: DOI.CAPOmbudsman@ky.gov

Last modified 02/02/2016

Louisiana

Louisiana Department of Insurance
Office of Health Insurance
P.O. Box 94214
Baton Rouge, LA 70804
225-342-5301
800-259-5301
http://www.ldi.louisiana.gov/

Last modified 02/02/2016

Maine
Consumer Assistance Program:

Maine Health Insurance Consumer Assistance Program (MHICAP)
P.O. Box 2490
Augusta, ME 04338
1-800-965-7476
http://www.mainecahc.org

Maine Department of Insurance - for insured plans only
Department of Professional & Financial Regulation 
Maine Bureau of Insurance
34 State House Station
Augusta, ME 04333-0034
1-800-300-5000 (toll free in Maine)
207-624-8475
http://www.maine.gov/pfr/insurance/
email: Insurance.PFR@maine.gov

Last modified 02/12/2016

 

Marshall Islands

A list of consumer assistance resources for residents of this territory is not available.

Last modified 06/14/2013

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
email: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
410-468-2090
800-492-6116
http://www.insurance.maryland.gov/Pages/default.aspx

Last modified 02/12/2016

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

Last modified 02/02/2016

Michigan

Michigan Division of Insurance
611 W. Ottawa St., 3rd Floor
Lansing  MI 48933-1070
877-999-6442
https://www.michigan.gov/difs

Last modified 02/11/2016

The Federated States of Micronesia

A list of consumer assistance resources for residents of this territory is not available.

Last updated 06/14/2013

Minnesota

Minnesota Department of Commerce (for fully insured plans)
85 7th Place East, Suite 500
Saint Paul, MN 55101
651-539-1600
800-657-3602
TTY: 651-296-2860
http://mn.gov/commerce/consumers/your-insurance/index.jsp

Last modified: 02/02/2016

 

Mississippi
Consumer Assistance Program:

Health Help Mississippi
800 North President Street
Jackson, MS 39202
877-314-3843
www.healthhelpms.org
email: healthhelpms@mhap.org

Mississippi Department of Insurance - for insured plans only
P.O. Box 79
Jackson, MS 39205-0079
601-359-3569
800-562-2957 (Consumers Only)
http://www.mid.ms.gov
email: info@mid.ms.gov

Missouri

Missouri Division of Insurance
301 W. High St., Room 350
Jefferson City, MO 65101
573-751-4126
http://www.insurance.mo.gov/consumers/

Last modified 02/11/2016

Montana

Montana Commissioner of Securities and Insurance
840 Helena Avenue
Helena, MT 59601
In-state only: 800-332-6148
406-444-2040
TDD: 406-444-3246
http://csimt.gov/your-insurance/

Last modified 02/02/2016

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

Last modified 02/02/2016

Nevada

Nevada Division of Insurance
2501 East Sahara Ave., Suite 302
Las Vegas, NV 89104
702-486-4009
http://doi.nv.gov/Consumers/

Last modified 02/02/2016

New Hampshire

New Hampshire State Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
800-852-3416
TTY/TDD Relay Services: 800-735-2964
http://www.nh.gov/insurance/

email: consumerservices@ins.nh.gov

Last modified 02/03/2016

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

Last modified 02/03/2016

New Mexico
Consumer Assistance Program:

New Mexico 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

Last modified 02/11/2016

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

Last modified 02/12/2016

North Carolina
Consumer Assistance Program:

Health Insurance Smart NC
NC 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
NC Department of Insurance
Services for Consumers

1201 Mail Service Center
Raleigh NC 27699-1201
855-408-1212
http://www.ncdoi.com/Consumer

Last modified 02/12/2016

North Dakota

North Dakota Insurance Department
State Capitol, fifth floor
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
701-328-2440
800-247-0560
TTY: 800-366-6888
http://www.nd.gov/ndins/

email: insurance@nd.gov

Last modified 02/03/2016

Northern Mariana Islands

Department of Commerce
Box 5764 CHRB
Saipan, MP 96950
670-644-3005
http://cnmicap.wordpress.com

Last modified 02/04/2016

Ohio

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, OH 43215
800-686-1526
TDD: 614-644-3745
http://www.insurance.ohio.gov/Pages/default.aspx
email: life.health.mcd@insurance.ohio.gov

Last modified 02/03/2016

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

Last modified 02/03/2016

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

Last modified 02/03/2016

Palau

A list of consumer assistance resources for residents of this territory is not available.

Last modified 06/14/2013

Pennsylvania

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

Last modified 02/03/2016

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

Last modified 02/03/2016

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/

Last modified 02/03/2016

South Carolina

South Carolina Department of Insurance
P. O. Box 100105
Columbia, SC 29202
800-768-3467
803-737-6180
email: consumers@doi.sc.gov

Last modified 02/03/2016

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
email: insurance@state.sd.us

Last modified 02/03/2016

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

Last modified 02/11/2016

Texas

Texas Department of Insurance
333 Guadalupe Street
Austin, TX 78701
800-578-4677
http://www.tdi.texas.gov/index.html

Last modified 02/03/2016

Utah

Utah Insurance Department
State Office Building, Room 3110
Salt Lake City, UT 84114
801-538-3077
TDD: 801-538-3826
http://www.insurance.utah.gov
email: health.uid@utah.gov

Last modified 02/03/2016

Vermont

Vermont Division of Financial Regulation
89 Main Street
Montpelier, VT 05620-3101
802-828-3301
802-828-3302
800-964-1784
http://www.dfr.vermont.gov/insurance/health-insurance/health-insurance

Last modified 02/03/2016

 

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
email: bureauofinsurance@scc.virginia.gov

Last modified 02/03/2016

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

Last modified 02/03/2016

Washington

Washington State Office of the Insurance Commissioner
5000 Capitol Blvd., SE
Tumwater, WA 98501
800-562-6900
360-725-7080
TDD: 360-586-0241
https://www.insurance.wa.gov/your-insurance/
 email: cap@oic.wa.gov

Last modified 02/03/2016

West Virginia

West Virginia Department of Insurance
P. O. Box 50540
Charleston, WV 25305-0540
304-558-3386
888-879-9842
TDD: 304-558-1296
TDD: 800-435-7381
https://www.wvinroads.org

Last modified 02/03/2016

Wisconsin

Wisconsin Office of the Commissioner of Insurance
125 South Webster Street
Madison, WI 53703
800-236-8517
TDD: Dial 711 and ask for 608-266-3586
http://oci.wi.gov/consinfo.htm
email: ocicomplaints@wisconsin.gov

Last modified 02/03/2016

Wyoming

Wyoming Insurance Department
106 East 6th Avenue
Cheyenne, WY 82002
307-777-7401
800-438-5768 (within WY)
http://insurance.state.wy.us/
email: wyinsdep@state.wy.us

Last modified 02/03/2016

* 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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