The federal COVID-19 emergency is over.
Dispute & Appeals
Information to guide you
The dispute process made simple
The dispute process allows you to disagree with a claim or utilization review decision. Discover how and when to submit a dispute. Learn about the timeframe for appeals and reconsiderations. And find contact information for different issues.
Learn more about the dispute process
View our quick reference guide
Have more questions?
Read our FAQs. We have answers to many questions, including:
- What is a dispute?
- What is the procedure for disputing a claim decision?
- What is a reconsideration?
- What is an appeal?
State-specific information
We have state-specific information about disputes and appeals. We also have a list of state exceptions to our 180-day filing standard. Exceptions apply to members covered under fully insured plans.
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.
Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies. For a complete list of other participating pharmacies, log in to texashealthaetna.com
Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.
©2023 Texas Health + Aetna Health Plan Inc. & Texas Health + Aetna Health Insurance Company