Request for an Appeal of an Allina Health | Aetna Medicare Advantage (Part C) Plan Authorization Denial

Because Allina Health | Aetna Medicare (or one of our delegates) denied your request for coverage of a medical item or service or a Medicare Part B prescription drug, you have the right to ask us for an appeal of our decision. You have 60 calendar days from the date of your denial to ask us for an appeal. This form may be sent to us by mail or fax:

Have questions?

Allina Health | Aetna Medicare Advantage members may call us at 1-833-570-6671 (TTY: 711), 8 a.m. to 8 p.m. local time, 7 days a week.

Medicare Appeals Part C
Representation documentation for appeal requests made by someone other than enrollee or the enrollee's doctor: Your doctor may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. That person may already be your representative if you've filed paperwork with your state, such as Power of Attorney papers. For more information on appointing a representative, contact your plan or 1-800-Medicare 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Medicare Appeals Part C

Y0130_NR_3032_12748a_2020_C 03/2020

Page Last Updated: March 2020

Medicare Appeals Part C