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.
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
(800)-433-3966
Fax: (334)-956-7932
Alabama Department of Insurance website
Contact the Alabama Department of Insurance
Last modified 11/15/2018
Alaska
Alaska Division of Insurance
Anchorage Office
Division of Insurance
550 W. 7th Ave., Ste 1560
Anchorage AK 99501-3567
(907) 269-7900 or 1-(800)-INSURAK
Fax: (907) 269-7910
TTY/TTD: 700 or (800) 770-8973
Alaska Division of Insurance
Juneau Office
P. O. Box 110805
Juneau, AK 99811-0805
(907)-465-2515
Fax: (907)-465-3422
Alaska Division of Insurance website
Contact the Alaska Division of Insurance
Last modified 11/15/2018
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
Arizona Department of Insurance website
Contact the Arizona Department of Insurance
Last modified 11/15/2018
Arkansas
Arkansas Insurance Department
Consumer Services Division
1200 West Third St.
Little Rock, AR 72201
(501)-371-2640 (local)
(800)-852-5494
Arkansas Insurance Department website
Contact the Arkansas Insurance Department
Last modified 11/15/2018
California
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 complaint, appeal or grievance:
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 Department of Insurance - for insured Traditional plans only
Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, CA 90013
(800)-927-4357
1-(800)-482-4833 (TTY)
California Department of Insurance website
Contact the California Department of Insurance
California Department of Managed Health Care - for insured HMO and DMO plans only
980 9th St, Suite #500
Sacramento, CA 95814-2725
(888)-466-2219
(877)-688-9891 (TTY)
California Department of Managed Health Care website
Contact the California Department of Managed Health Care
Last updated 11/15/2018
Colorado
Department of Regulatory Agencies
Colorado Division of Insurance
1560 Broadway, Suite 850
Denver, CO 80202
(800)-930-3745
(303)-894-7499
Colorado Department of Regulatory Agencies website
Contact the Colorado Department of Regulatory Agencies
Last modified 11/15/2018
Connecticut
State of Connecticut Office of the Health Care Advocate
P.O. Box 1543
Hartford, CT 06144
866-466-4446
Fax: (860) 331-2499
Connecticut Office of the Health Care Advocate website
Connecticut Department of Insurance - for insured plans only
Consumer Affairs Unit
P.O. Box 816
Hartford, CT 06142-0816
(860) 297-3800 (Local)
800-203-3447
Connecticut Department of Insurance website
Contact the Connecticut Department of Insurance
Last modified 11/15/2018
Delaware
Insurance Commissioner and Department of Insurance
841 Silver Lake Blvd.
Dover, DE 19904
302-674-7300
Delaware Insurance Commissioner and Department of Insurance website
Contact the Delaware Insurance Commissioner and Department of Insurance
Last modified 11/15/2017
District of Columbia (DC)
Consumer Assistance Program:
Health Care Ombudsman
One Judiciary Square
441 4th St., NW 900 South
Washington, DC 20001
(202) 724-7491
Fax: (202) 442-6724
TTY: 711
Alternate Number: 1(877) 685-6391
District of Columbia Healthcare Finance website
The District of Columbia Department of Insurance Securities and Banking - for insured plans only
1050 First Street, NE, Suite 801
Washington, DC 20002
(202) 727-8000
Fax: (202) 535-1196
TTY: 711
District of Columbia Insurance Securities and Banking website
Last modified 11/15/2018
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)-640-0886 (TDD)
Florida Department of Financial Services website
Last modified 11/15/2018
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
Georgia Office of Insurance and Safety Fire Commissioner website
Last modified 11/15/2018
Guam
Guam Department of Insurance
Dept. of Revenue & Taxation
Taxpayer Services Division
P.O. Box 23607
GMF, Guam 96921
Fax: (671)-633-2643
Guam Department of Insurance website
Last modified 06/28/2018
Hawaii
Hawaii Department of Commerce and Consumer Affairs
Hawaii Insurance Division
King Klakaua
335 Merchant Street, Rm 213
Honolulu, HI 96813
(808)-586-2790
(808)-586-2799
Hawaii Department of Commerce and Consumer Affairs website
Contact the Hawaii Department of Commerce and Consumer Affairs
Last modified 11/15/2018
Idaho
Idaho Department of Insurance
700 West State Street, 3rd Floor
P.O. Box 83720
Boise, ID 83720-0043
(800)-721-3272
(208)-334-4319
Idaho Department of Insurance website
Contact the Idaho Department of Insurance
Last modified 11/15/2018
Illinois
Illinois Department of Insurance
Office of Consumer Health Insurance
Consumer Services Section
122 S. Michigan Ave. 19th Floor
Chicago, IL 60603
Or
Springfield Office
320 W. Washington S.
Springfield, IL 62727-0001
(877)-527-9431
Illinois Department of Insurance - for insured plans only
Office of Consumer Health Insurance
320 West Washington Street
Springfield, Illinois 62767-0001
1-(877)-527-9431 toll free 1-(217)-558-2083 Fax number
Illinois Department of Insurance website
Last modified 11/15/2018
Indiana
Indiana Department of Insurance
Consumer Services Department
311 W. Washington Street, Suite 300
Indianapolis, IN 46204
(800)-622-4461
Indiana Department of Insurance website
Last modified 11/15/2018
Iowa
Iowa State Insurance Division
Consumer Advocate Bureau
601 Locust St. 4th fl.
Des Moines, Iowa 50309
(515)-281-4038
(877)-955-1212
Iowa State Insurance Division website
Contact the Iowa State Insurance Division
Last modified 11/15/2018
Kansas
Kansas Insurance Department
Consumer Assistance Division
420 SW 9th Street
Topeka, KS 66612
(800)-432-2484 (in state)
(785)-296-3071 (all others)
Kansas Insurance Department website
Last modified 11/15/2018
Kentucky
Kentucky Health Insurance Advocate
Department of Insurance
P.O. Box 517
Frankfort, KY 40602-0517
(800) 595-6053 or (502)-564-6034
(800)-648-6056 (TYY)
Kentucky Health Insurance Advocate website
Last modified 11/15/2018
Louisiana
Louisiana Department of Insurance
Office of Health Insurance
P.O. Box 94214
Baton Rouge, LA 70804
(225)-342-5900
(800)-259-5301
Louisiana Department of Insurance website
Last modified 011/15/2018
Maine
Maine Consumer Assistance
Maine Health Insurance Consumer Assistance Program (MHICAP)
P. O. Box 2490
12 Church St.
Augusta, ME 04338
(800) 965-7476
Maine Consumers for Affordable Health Care website
Contact the Maine Consumers for Affordable Health Care Program
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
(207) 624-8475 (In Maine)
(800)-300-5000
Maine Department of Insurance website
Contact the Maine Department of Insurance
Last modified 11/15/2018
Marshall Islands
A list of consumer assistance resources for residents of this territory is not available.
Last modified 06/14/2013
Maryland
Maryland Office of the Attorney General
Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202
(877) 261-8807
Contact Maryland Attorney General
Maryland Department of Insurance - for insured plans only
Maryland Insurance Administration
Consumer Complaint Investigation
Life and Health/Appeals and Grievances
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
(410) 468-2000 or (800)-492-6116
TTY: 1-800-735-2258
Fax: (410) 468-2270 or (800)-468-2260 (Life and Health/Appeals and Grievance)
Maryland Department of Insurance website
Last modified 11/15/2018
Massachusetts
Massachusetts Division of Insurance
Customer Services Division
Health Policy Commission
Office of Patient Protection
50 Milk Street
Boston MA 02109
800-436-7757
Fax: 1-617-624-5046
Massachusetts Division of Insurance website
Last modified 11/15/2018
Michigan
Michigan Division of Insurance (HICAP)
530 W. Allegan Street, 7th Floor
Lansing, MI 48933
(877)-999-6442
Michigan Division of Insurance website
Michigan Division of Insurance - for insured plans only
Michigan Department of Insurance and Financial Services (DIFS)
PO Box 30220
Lansing, MI 48909-7720
(877)-999-6442
Michigan Division of Insurance website
Last modified 11/15/2018
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
Minnesota Department of Commerce website
Contact the Minnesota Department of Commerce
Minnesota Department of Health (for state-regulated HMO)
Managed Care Systems Section
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Minnesota Department of Health
Contact the Minnesota Department of Health
Last modified 11/15/2018
Mississippi
Mississippi Department of Insurance
P.O. Box 79
Jackson, MS 39205-0079
(800)-562-2957
Mississippi Department of Insurance website
Contact the Mississippi Department of Insurance
Last Modified 11/15/2018
Missouri
Missouri Division of Insurance
301 W. High St., Room 350
Jefferson City, MO 65101
(573)-751-4126
Missouri Division of Insurance
Last modified 11/15/2018
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
Contact the Montana Commissioner of Securities and Insurance
Last modified 11/15/2018
Nebraska
State Department of Insurance
Nebraska Department of Insurance
P. O. Box 82089
Lincoln, NE 68501-2089
(877)-564-7323
(800)-833-7352 (TTD)
Nebraska State Department of Insurance website
Last modified 11/15/2018
Nevada
Office of Consumer Health Assistance
Governor’s Consumer Health Advocate
555 East Washington Avenue #4800
Las Vegas, Nevada 89101
(702)-486-3587
(888)-333-1597
Nevada Division of Insurance website
Nevada Division of Insurance - for insured plans only
3300 W. Sahara Ave., Suite 275
Las Vegas, Nevada 89102
(702)-486-4009
Nevada Division of Insurance website
Last modified 11/15/2018
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
New Hampshire State Insurance Department website
Contact the New Hampshire State Insurance Department
Last modified 11/15/2018
New Jersey
New Jersey State Insurance Department
The Office of the Insurance Ombudsman
NJ Department of Banking and Insurance
20 West State Street
P.O. Box 472
Trenton, NJ 08625-0472
1-(800)-446-7467 or
Fax: (609)-292-2431
New Jersey State Insurance Department website
Office of Managed Care - for insured plans only
Consumer Protection Services
NJ Department of Banking and Insurance
P.O. Box 329
Trenton, NJ 08625-0329
1-(888)-393-1062 or
Consumer Hotline: (800)-446-7467
New Jersey State Insurance Department website
Last modified 11/15/2018
New Mexico
New Mexico HICAP
Health Insurance Consumer Assistance
1120 Paseo de Peralta
Santa Fe, NM 87501
1-(855)-857-0972
New Mexico Department of Insurance website
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
(505)-827-4601
Fax: (505)-476-0326
New Mexico Department of Insurance website
New York
Community Health Advocates
633 Third Avenue 10th Floor
New York NY 10017
1-(888)-614-5400
New York Community Health Advocate website
Department of Financial Services - for insured plans only
Consumer Assistance Unit
One State Street
New York, NY 10004-1511
(800)-342-3736
New York Department of Financial Services website
Last modified 11/15/2018
North Carolina
Consumer Assistance Program:
Health Insurance Smart NC
NC Department of Insurance
Consumer Assistance Unit
1201 Mail Service Center
Raleigh, NC 27699-1201
(855)-408-1212
Health Insurance Smart NC website
Last modified 11/15/2018
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
North Dakota Insurance Department website
Last modified 11/15/2018
Northern Mariana Islands
Department of Commerce
Box 5764 CHRB
Saipan, MP 96950
(670)-644-3005
CNMI Consumer Assistance Program website
Last modified 02/04/2016
Ohio
Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, OH 43215
(614)-644-2658
TDD: (614)-644-3745
(800)-686-1526
Ohio Department of Insurance website
Last modified 11/15/2018
Oklahoma
Oklahoma Insurance Department
Oklahoma City Office
Five Corporate Plaza
3625 NW 56th, STE 100
Oklahoma City, OK 73112
(918)-295-3700 (Local)
(405)-521-2991
(800)-522-0071(in state only)
Fax: (405)-521-6652
Tulsa Office
Oklahoma Insurance Department
7645 E. 63rd St., Suite 102
Tulsa, OK 74133
(800)-522-0071(in state only)
(405)-521-2828
Oklahoma Insurance Department website
Last modified 11/15/2018
Oregon
Oregon Division of Insurance
350 Winter St NE
Salem, OR 97309-0405
(888)-877-4894
Oregon Division of Insurance website
Last modified 11/15/2018
Palau
A list of consumer assistance resources for residents of this territory is not available.
Last modified 10/09/2014
Pennsylvania
Pennsylvania Department of Insurance
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA 17120
(877)-881-6388
Fax: (717)-787-8585
TYY/TDD: (717)-783-3898
Pennsylvania Department of Insurance website
Last modified 11/15/2018
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
Puerto Rico Department of Insurance website
Puetro Rico Office of the Commissioner of Insurance website
Last modified 08/01/2017
Rhode Island
RI Insurance Resource, Education, and Assistance Consumer Helpline (RIREACH)
1210 Pontiac Avenue
Cranston, RI 02920
1-(855)-747-3224
Rhode Island Office of Health Insurance Commissioner website
Last modified 11/15/2018
South Carolina
South Carolina Department of Insurance
P. O. Box 100105
Columbia, SC 29202
(800)-768-3467
(803)-737-6180
Fax: (803) 737-6231
South Carolina Department of Insurance website
Contact the South Carolina Department of Insurance
Last modified 11/15/2018
South Dakota
South Dakota Department of Labor and Regulation
124 South Euclid Ave., 2nd floor
Pierre, SD 57501
(605)-773-3563
South Dakota Division of Insurance website
Last modified 11/15/2018
Tennessee
Tennessee Department of Commerce and Insurance
Consumer Insurance Services
500 James Robertson Parkway, 4th Floor
Nashville, Tennessee 37243
(800)-342-4029
(615)-741-2241
Fax: (615)-532-7389
Tennessee Department of Commerce and Insurance website
Last modified 11/15/2018
Texas
Texas Department of Insurance
333 Guadalupe Street
Mail Code 111-1A
P.O. Box 14909
Austin TX 78714-9091
1-(800)-252-3439
Texas Department of Insurance website
Texas Department of Insurance - for insured plans only
PO Box 149091
Austin, TX 78714-9091
1-(800)-252-34
Fax: (512)-490-1007
Texas Department of Insurance website
Last modified 11/15/2018
Utah
Utah Insurance Department
State Office Building, Room 3110
Capitol Hill Complex
350 N State St.
Salt Lake City, UT 84114
Salt Lake area: (801)-538-3800
In-state toll-free: (800)-439-3805
Utah Insurance Department website
Contact the Utah Insurance Department
Last modified 11/15/2018
Vermont
Vermont Division of Financial Regulation
89 Main Street
Montpelier, VT 05620-3101
(802)-828-3301
(800)-964-1784
Vermont Division of Financial Regulation website
Last modified 11/15/2018
Virginia
Virginia State Corporation Commission
Bureau of Insurance
P.O. Box 1157
Richmond, Virginia 23218-1157
(800)-552-7945 (Virginia only)
(804)-371-9741
Virginia State Corporation Commission website
Contact the Virginia State Corporation Commission
Last modified 11/15/2018
Virgin Islands
U.S. Virgin Islands Division of Banking and Insurance
1131 King Street, Suite 101
Christiansted, St. Croix, VI 00820
(340)-773-6459
U.S. Virgin Islands Division of Banking and Insurance website
Last modified 08/01/2017
Washington
Washington State Office of the Insurance Commissioner
Consumer Protection Division
P.O. Box 40256
Olympia, WA 98504-0256
(800)-562-6900
Fax: (360)-586-2018
Washington State Office of the Insurance Commissioner website
Contact the Washington State Office of the Insurance Commissioner
Last modified 11/15/2018
West Virginia
West Virginia Department of Insurance
ATTN: Consumer Service Division
P. O. Box 50540
Charleston, WV 25305-0540
(304)-558-3386
(888)-879-9842
TDD: (304)-558-1296
TDD: (800)-435-7381
West Virginia Department of Insurance website
Last modified 11/15/2018
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
Wisconsin Office of the Commissioner of Insurance
Contact the Wisconsin Office of the Commissioner of Insurance
Last modified 11/15/2018
Wyoming
Wyoming Insurance Department
106 East 6th Avenue
Cheyenne, WY 82002
(307)-777-7401
(800)-438-5768 (within WY)
Wyoming Insurance Department
Contact the Wyoming Insurance Department
Last modified 11/15/2018
* 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
