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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:

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

You may mail or fax your information by printing the following 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.

Our Collaboration

We’re a health care company that 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. Together we bring a performance network†† to market with a goal to deliver a differentiated and personalized experience for members, designed to improve efficiency and lower the cost of care.

Great care, great value, always there for Northern Californians. 

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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 APG††Performance network refers to a network of providers who are clinically integrated.

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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 its affiliates (Sutter) and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna, CVS Pharmacy, Inc. (which owns CVS® HealthHub® locations), 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.

This material is for information only and is not an offer or invitation to contract. Health insurance plans contain exclusions and limitations. Not all health services are covered. See plan documents, consult with HR/Benefits Manager or call the member services number on the back of your ID card for details on benefits, exclusions, limitations and conditions of coverage. Providers are independent contractors and not our agents. Provider participation may change without notice. Sutter Health | Aetna does not provide care or guarantee access to health services. 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.

Language Assistance 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…

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