Aetna request for external review form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your Member Information. Enter your full name, Member ID Number, and address including street, city, state, and ZIP code. Don’t forget to include your telephone numbers for home, work, and office.
3. Next, provide the Treating Healthcare Provider's information. Fill in their name, address, and telephone numbers as required.
4. In the 'Request for External Review' section, clearly indicate that you are requesting an external review for a coverage determination. Remember to attach a copy of the coverage denial letter along with any other relevant information you wish to be considered.
5. Sign the form where indicated. If someone is signing on your behalf as an Authorized Representative, ensure they complete their section with all necessary details.
6. Finally, review all entered information for accuracy before submitting the completed form and attachments to Aetna’s National External Review Unit at the provided address.

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