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X 14079 Lexington, KY 40512-4079 Fax to: 1-859-455-8650 Phone: 1-888-772- 9682 Ask your physician to complete the Attending Physician's Statement on the reverse side. Return completed form to employer. 1. Employer Information Name Control Number Address (include ZIP Code) 2. Employee Information Social Security Number Name Birthdate (MM/DD/YYYY) Address (include ZIP Code) Daytime Telephone Number ( Has your employment terminated and/or are you currently on layoff? ) No Basic Income.

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Urgent care claims You or your doctor may ask for an "expedited" appeal. Call the toll-free number on your Member ID card or the number on the claim denial letter. If your plan has one level of appeal, we'll tell you our decision no later than 72 hours after we get your request for review.

For general claims inquiry: please call 1-855-221-5656 Monday - Friday, 8 a.m. -5 p.m. You may also contact this number for more information on the claims inquiry process.

We require providers to submit claims within 180 days from the date of service unless otherwise specified within the provider contract.

For general inquiries, reach our Corporate Headquarters at 1-800-US-AETNA (1-800-872-3862). There is no option for members to get information at this number. The Corporate Headquarters phone lines are staffed Monday through Friday, 8 a.m. - 6 p.m. ET.

How to ask for medical coverage or request an appeal for a service. If you have a Medicare Advantage plan and you're requesting a medical service, you'll ask for a coverage decision (organization determination). You can call us, fax or mail your information. Call: 1-800-245-1206 (TTY: 711), 7 days a week, 8 AM to 8 PM.

How do I change my name or address? Give changes of name or address to the employer through which you have Aetna coverage. The employer will send this information to us. If you are covered by a plan you purchased on the exchange (also called the Health Insurance Marketplace), you should contact the plan directly.

Write: Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512. *The timeframe is 180 calendar days for appeals involving utilization review issues or claims issues based on medical necessity or experimental/investigational coverage criteria.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232