Get Aetna Gr-68192 2018-2026

Filling out the Aetna GR-68192 form online is a straightforward process that allows you to submit your complaint or appeal efficiently. This guide provides step-by-step instructions to ensure you complete the form correctly.

Follow the steps to complete your Aetna GR-68192 form effectively.

1. Use the ‘Get Form’ button to access the Aetna GR-68192 form online and open it in the editor.
2. Enter today’s date in the specified field.
3. Input the member’s ID number, which can be found on the front of your ID card.
4. Select the plan type, either Medical or Dental.
5. Fill in the member’s first and last name.
6. If applicable, enter the member’s group number, which is optional.
7. Provide the member’s birthdate in the format MM/DD/YYYY.
8. Include the member’s email address for communication purposes.
9. Now, provide the information for the person you are submitting the request for, including their first name, last name, and birthdate.
10. Indicate the relationship of the requester to the person for which the appeal is being submitted: Self, Partner, Child, or Other.
11. Specify if the appeal relates to a Pre-Service or Post-Service situation.
12. If Post-Service is selected, enter the claim ID number. If Pre-Service is selected, provide the reference number.
13. Input the service date according to the type of appeal selected.
14. Clearly articulate your explanation of the request. Utilize additional pages if necessary to provide comprehensive details.
15. The member must sign the form at the designated area.
16. After completing the form, include any required documents such as bills and correspondence, and send your request by mailing it to Aetna’s designated address or through the national fax number.

Complete your Aetna GR-68192 form online today for a timely resolution.