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Appeals and grievances online form

I want to file an appeal or grievance

1. Appeal or grievance details
 

Tell us about the appeal or grievance in the fields below. You’ll want to fill in all fields with an asterisk (*).

 

*Check one:
For appeals, give the date on the Notice of Action letter you received. For grievances, give the date of the issue or event.
Tell us about the appeal or grievance. You can send us medical records or other information to support your appeal. Since there are risks of sharing information via email, we remind you to send your email securely. To send in your requests securely, you can also use the OhioRISE member portal.


2. Member information

Share your information in the fields below. You’ll want to fill in all fields with an asterisk (*).

Example: 12345
Example: 1234567890
*Are you filing this appeal or grievance for someone else?

 

Expedited appeals

 

You can ask for an expedited appeal if you or your provider believes our standard time frame of 15 days to make an appeal decision will risk your life or health.

Today's date

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You can send us more information by:

 

Non-discrimination notice

Aetna Better Health® of Ohio follows state and federal civil rights laws that protect you from discrimination or unfair treatment.

 

Read our full non-discrimination notice

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