Grievance and Appeals

We want you to be happy with services you get from Aetna Better Health of Kansas and our providers. If you are not happy, we want you to let us know. We take member grievances very seriously. We want to know what is wrong so we can make our services better.

You or your representative will be able to file a grievance with us in writing, verbally through the toll-free Member Services number at 1-855-221-5656 (TTY: 711), to any member of our health plan staff or through the website, contact us.

All member information will be handled confidentially. We will not discriminate against any member who has filed a grievance.

Through Member Services, you will have access to language line interpreters, translation services and alternate formats such as large print, Braille and TTY as needed at no cost to you. Our staff will help explain the process and the forms needed.

A grievance is a written or verbal expression of dissatisfaction about any matter other than an Adverse Benefit Determination.

You can file a grievance at any time if you’re not happy with our service. Filing a grievance means you’re letting us know about services with which you’re not happy.

Examples of a grievance:

  • You are unhappy with the quality of care or services provided
  • You have not gotten services that Aetna Better Health of Kansas has approved
  • Your provider or a plan staff member did not respect your rights
  • You had trouble getting an appointment with your provider in the appropriate amount of time
  • Your provider or a plan staff member was rude to you
  • You cannot get culturally competent care

You can call Member Services at the number below if you need help filing a grievance or if you need assistance in another language or format. Our phone number is 1‑855-221-5656, (TTY: 711). We are available 24 hours a day, 7 days a week.

You can also file a grievance in person, in writing,  or by mailing or faxing it to us at:

Aetna Better Health of Kansas
Grievance and Appeal Department
9401 Indian Creek Parkway, Suite 1300
Overland Park, KS 66210

Fax: 1-833-857-7050

You can also have someone else act on your behalf, such as an attorney, a family member, friend or provider. Send us a letter telling us that you want someone else to represent you and file a grievance for you. Include your name, member ID number from your ID card, the name of the person you want to represent you and what your grievance is about. You can also complete the authorized representative form.

Authorization form

We’ll send you a letter letting you know we got your grievance within five calendar days, unless the grievance was resolved on the same day it was received by Aetna Better Health.

We’ll send you a letter to let you know what we did about your problem within 30 calendar days of the date we get your grievance.

If your grievance is related to your request for an expedited (faster) appeal or an extension, we will respond within 72 hours after the receipt of the grievance.

We’ll never punish or discriminate against you or your provider, or take any negative action against either of you in any way for filing any kind of grievance or appeal.

The KanCare Ombudsman provides help to KanCare members who receive long-term care and community based services. The Ombudsman can assist you:

  • When you do not think that you are getting the care that you need.
  • When you feel your rights are being violated.
  • When you feel you have not received culturally appropriate care.

You can contact the KanCare Ombudsman by phone or email:

An adverse benefit determination is when we send you a letter to tell you that we are terminating, suspending, reducing or denying a service or benefit. An appeal is a request for review of an adverse benefit determination.

You have the right to appeal any adverse benefit determination (decision) by Aetna Better Health that you disagree with that relates to coverage or authorization of services.

Examples of Appeals:

  • Request for a health care service, supply, item or drug that you think you should be able to get
  • Aetna Better Health of Kansas stops providing or paying for all or a part of a service or drug you receive that you think you still need.

If you are not satisfied with a decision we made about your service authorization request, or the termination, suspension or reduction of your services you have 60 calendar days from the date of the adverse benefit determination notice to file an appeal. We will allow an additional 3 calendar days for mailing. We will not treat you unfairly because you file an appeal.

You can call Member Services if you need help filing an appeal or if you need assistance in another language or require an alternate format. Our phone number is  1‑855-221-5656, (TTY: 711). We are available  24 hours a day, 7 days a week.

Send your Appeal request to:

Aetna Better Health of Kansas
Grievance and Appeal Department
9401 Indian Creek Parkway, Suite 1300
Overland Park, KS 66210

Fax: 1-833-857-7050

You can ask someone to file the appeal for you. You can choose anyone you want, including a friend, your provider, a legal guardian, a relative or an attorney. If you pick a person to do the appeal for you, that person is your authorized representative.

You must write us a letter with the name of the person who will speak for you. Be sure to sign it. You can also fill out an authorized representative form to let the person you chose speak for you as your Representative. We can also send you the form. Just call us at 1-855-221-5656, (TTY: 711), 24 hours a day, 7 days a week.

Once we receive your appeal request, we will send you a letter within 5 calendar days to let you know we got it. If we have all the information we need, we will tell you our decision within 30 calendar days of when we receive your appeal request. We will send you a written appeal resolution letter.

There’s a fast appeal process called an expedited appeal. You can ask for an expedited appeal if your life or health could be harmed by us taking the normal time to finish your appeal. Call us at 1-855-221-5656, (TTY: 711), 24 hours a day, 7 days a week to let us know if you need an expedited appeal.  Decisions will be made within 72 hours of receipt of your appeal. We will tell you our decision by phone within 72 hours, followed by a written notice.

If your request to expedite the appeal isn't approved, we will call you to let you know. We will also send you a letter within 2 calendar days of receiving your request.

If you disagree with our decision on your appeal request, you can appeal directly to The Office of Administrative Hearings. This process is known as a State Fair Hearing. You may also submit a request for a State Fair Hearing if we do not respond to an appeal request for services within the times described in your member handbook. The State requires that you first exhaust (complete) Aetna Better Health of Kansas appeals process before you can file a State Fair Hearing request through the State Fair Hearing process.

You can request a State Fair Hearing within 120 calendar days from the date of the Appeal Resolution Letter. We will allow an additional 3 calendar days for mailing. You can do this in three ways:

  • Call Aetna Better Health at 1‑855-221-5656, (TTY: 711)
  • Send us a letter asking us to file a State Fair Hearing

Aetna Better Health of Kansas
Grievance and Appeal Department
9401 Indian Creek Parkway, Suite 1300
Overland Park, KS 66210

Fax: 1-833-857-7050

Office of Administrative Hearings
1020 S. Kansas Ave.
Topeka, Kansas 66612