Grievances & Appeals

Members or their designated representative can file a request for an appeal or grievance with Aetna Better Health of Kansas orally or in writing.

A representative is someone who acts on the member’s behalf, including but not limited to a family member, friend, guardian, provider, or an attorney. Representatives must be designated in writing. A provider, acting on behalf of a member, and with the member’s written consent, may file a grievance or appeal with Aetna Better Health of Kansas. Members and their representatives including providers with written consent may also file a State Fair Hearing as appropriate. When a provider acts on behalf of a member the request follows the member appeal and grievance processes and timeframes. 

Aetna Better Health of Kansas informs members and providers of the appeal and grievance processes for grievances, appeals and State Fair Hearings. This information is also contained in the Member Handbook. When requested, we give members reasonable assistance in completing forms and taking other procedural steps. Our assistance includes, but is not limited to, providing interpreter services and toll-free numbers that have adequate TTY/TTD and interpreter capability at no cost to the member.

Both network and out-of-network providers may file a grievance verbally or in writing directly with Aetna Better Health of Kansas in regard to our policies, procedures or any aspect of our administrative functions that is not requesting review of an action within 180 calendar days from the incident. Providers can also file a verbal grievance with Aetna Better Health of Kansas by calling 1-855-221-5656. To file a grievance in writing, providers should write to:

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

An acknowledgement letter will be sent within 10 calendar days summarizing the grievance and will include instruction on how to:

  • Revise the grievance within the timeframe specified in the acknowledgement letter
  • Withdraw a grievance at any time until Grievance Committee review

If the grievance requires research or input by another department, the Appeals and Grievance Manager will forward the information to the affected department and coordinate with the affected department to thoroughly research each grievance using applicable statutory, regulatory, and contractual provisions and our written policies and procedures, collecting pertinent facts from all parties. The grievance with all research will be presented to the Grievance Committee for decision. The Grievance Committee will include a provider with same or similar specialty if the grievance is related to a clinical issue. The Grievance Committee will consider the additional information and will resolve the grievance. 

Aetna Better Health of Kansas will resolve all provider grievances within 30 calendar days of receipt of the grievance and will notify the provider of the resolution within 5 calendar days of the decision.

A provider may request a reconsideration if they would like us to review the adverse payment decision. A reconsideration, which is optional, is available to providers prior to submitting an appeal. Reconsideration requests must be submitted within 120 calendar days (an additional 3 calendar days is allowed for mailing time) from the date of the notice of the adverse action.

Providers may submit reconsideration requests orally by contacting the Provider Experience department at 1-855-221-5656, (TTY: 711). Providers can submit a written reconsideration to:

Aetna Better Health of Kansas
Attn: Reconsideration
9401 Indian Creek Parkway, Suite 1300
Overland Park, KS 66210

Fax: 1-833-857-7050

We acknowledge provider reconsiderations in writing within 10 calendar days of receipt. Aetna Better Health will review your reconsideration request and provide a written response within 30 calendar days of receipt.

A provider may file an appeal in writing about an adverse payment decision, if they are not satisfied with the outcome of the reconsideration determination or if they wish to bypass the reconsideration process. A provider may file an appeal within 60 calendar days (an additional 3 calendar days is allowed for mailing time) from the date of the notice of adverse action if no reconsideration was requested. If reconsideration was requested, providers have 60 calendar days (an additional 3 calendar days for mailing time) from the date of the reconsideration resolution letter. Post service items or services are standard appeal and are not eligible for expedited processing.

All written appeals should be sent to the following: 

Aetna Better Health of Kansas
Appeal and Grievance Manager
9401 Indian Creek Parkway, Suite 1300
Overland Park, KS 66210
Fax: 1-833-857-7050

An acknowledgement letter will be sent within 10 calendar days of receipt summarizing the appeal and will include instruction on how to:

  • Revise the appeal within the timeframe specified in the acknowledgement letter
  • Withdraw an appeal at any time until Appeal Committee reviews.  The appeal along with all research will be presented to the Appeal Committee for decision. The Appeal Committee will include a provider with same or similar specialty. The Appeal Committee will consider the additional information and will issue a written appeal decision within 30 calendar days of receipt.

Providers may request a State Fair Hearing through the Office of Administrative Hearings after the appeal with Aetna Better Health. This request must be completed within 120 calendar days (with an additional 3 calendar days for mailing time), following the date of the appeal resolution letter. Information on how to submit a State Fair Hearing request is included in Appeal Resolution Letter.

Providers may request a State Fair Hearing for a denial of payment for covered and non-covered services.  Providers may also request a State Fair Hearing regarding an incorrect payment by Aetna Better Health or a notice from Aetna Better Health regarding an overpayment.

The request for a State Fair Hearing must be submitted in writing to the following:

State of Kansas
Office of Administrative Hearings
1020 S. Kansas Ave.
Topeka, KS 66612-1327