Quality Matters
It is important to us that you receive quality health care and member service.
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Have a Problem?
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Our goal is to correct any problems our members may have. If you have a problem, call Member Service.
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What is a Grievance?
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A grievance is when you are not happy with a service you received. An example may be a long wait time at your doctor’s office. Another example may be your overall satisfaction with the health care services you received.
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Who can File a Grievance?
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Members or someone for a member (a friend, family member or doctor).
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When and How can I file a Grievance?
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You can file a grievance by calling or writing Customer Service. A grievance may be filed any time you are unhappy with your health care services.
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What if I’m not Happy After Customer Service has Tried to Help Me?
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If you are not happy with the outcome of your grievance, you may file an Appeal under the Grievance and Appeals Program (GAP). Read the Grievance and Appeals section of your Member Handbook or call Customer Service to learn how to file an Appeal.
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Member Satisfaction Survey
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The health plan completes a Member Satisfaction Survey each year. The results are reported through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) system. This report helps us improve the services we are providing for you.
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Quality Report
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The Quality Report is a focus on Population Health: Preventative care for children, pregnant women and adults. Aetna’s goal is to promote wellness and prevention for all enrollees with the Plan. This report is published to communicate rates related to the delivery of healthcare to Aetna members at the provider level.