The name of the company that made the redetermination (the company that handled the Medicare claim in Level 1). You can find this information on the Medicare Summary Notice or the redetermination notice.

1. The Medicare Advantage (MA) program allows Medicare beneficiaries to receive benefits through private plans
rather than the traditional fee-for-service (FFS) program. Aetna Medicare is a PDP, HMO, PPO plan with a
Medicare contract. Medicare Advantage holds the promise of additional coverage for beneficiaries in a cost-
controlled payment system achieved through collaboration with private insurers. A recent investigation by the U.S.
Office of Inspector General found between 2014 and 2016, Medicare Advantage organizations overturned 75
percent of their preauthorization and payment denials upon appeal.
If you would like to provide feedback regarding your Medicare plan, you can contact Customer Service toll-free at
1-877-699-5710 (TTY: 711), 8 a.m. - 8 p.m., local time, 7 days a week or you can provide feedback directly to
Medicare through their Complaint Form about your Medicare health plan or prescription drug plan.
This resource provides an overview of the Medicare Part A and Part B administrative appeals How to Appeal
Medicare Advantage Denial process available to beneficiaries, providers, physicians and other suppliers who
provide services and supplies to Medicare beneficiaries. This will list each Medicare item or service you got from
that provider.
Pre-service appeals will be decided in 30 days and post-service appeals 60 days. But it added that it already uses
several tools to oversee the Advantage program and ensure that enrollees have adequate access to healthcare
services, including regular audits and enforcement actions.
We will issue an acknowledgement letter within five (5) days of receiving a payment dispute, and a decision letter
within thirty (30) days of receipt. Talk to your health plan about how to file appeals and your rights. You must send
your appeal to Network Health in writing within 60 calendar days after the date of the denial.
You can also contact your Medicare Advantage Plan for information regarding your appeal rights. If you are filing
an expedited appeal, the Council should issue a decision within 5 days. For more information on Keystone 65
Medical-Only HMO's prior authorization process and what services require prior authorization, please reference
Chapter 4, Section 2.1 on page 45 in your EOC or click on the link below.