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Complaints, Grievances and Appeals

How to file a complaint, grievance or appeal

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

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

Print and complete the form. Submit by following the instructions provided at the bottom of the 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.

Texas

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

Language services can be provided by calling the number on your member ID card. For additional language assistance: Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…

Health benefits and health insurance plans are offered and/or underwritten by Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna). Each insurer has sole financial responsibility for its own products. Texas Health Aetna are affiliates of Texas Health Resources and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Texas Health Aetna.

Self-funded plans are administered by Texas Health + Aetna Health Insurance Company.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and not our agents. Provider participation may change without notice. We do not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability are subject to change and may vary by location. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are part of the delivery system or physician group. Information is believed to be accurate as of the production date; however, it is subject to change.

Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.

©2021 Texas Health + Aetna Health Plan Inc. & Texas Health + Aetna Health Insurance Company