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Dispute and Appeals Overview

Information to guide you

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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 dispute process quick reference guide

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Have more questions?

You can read our Frequently Asked Questions. 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?

See frequently asked questions

 

Our Collaboration

The new joint venture brings together Sutter Health’s network of nationally recognized, high-quality* doctors and hospitals with Aetna’s leading health plan expertise, cutting-edge data, analytics and health information technology, and shared care management capabilities. This joint venture aims to deliver a differentiated, personalized experience for members and is designed to improve efficiency and lower the cost of care, resulting in greater affordability.

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*Many of the hospitals and physician organizations in the Sutter Health network have been recognized for quality achievements from The Joint Commission, The Leapfrog Group®, Integrated Healthcare and CAPG.

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Health benefit plans are administered by Sutter Health and Aetna Administrative Services LLC. Sutter Health | Aetna is the brand name used for products and services provided by Sutter Health and Aetna Administrative Services LLC. Sutter Health | Aetna is an affiliate of Sutter Health and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Sutter Health | Aetna.

This material is for information only and is not an offer or invitation to contract.  Health benefit 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. Information is believed to be accurate as of the production date; however, it is subject to change.

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You are now being redirected to www.sutterhealth.org. Health benefit plans are administered by Sutter Health and Aetna Administrative Services LLC (Sutter Health | Aetna). Sutter Health | Aetna is an affiliate of Sutter Health, and of Aetna Life Insurance Company and its affiliates (Aetna).

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