Mibee KUEE UIT Keen’ 3 wL2e ‘Aetna Better Health’ of Louisiana 2400 Veterans Memorial Blvd, Suite 200 Kenner, LA 70062 09/01/2022 Mr.JEFFREY T BODIN 528 BEAU CHENE DR MANDEVILLE, LA, 70471 Subject: Grievance Acknowledgment Member Name: JEFFREY BODIN Member ID: 5794038645696 Dear JEFFREY BODIN: ~ 8f-10 vaetna 5 If you need this in larger print or another format, call Member Services at Llame hoy mismo al 1-855-242-0802, TTY 7-1-1 si usted desea recibir esta carta en espaiiol Aetna Better Health of Louisiana received your grievance about your request for proof of your past appointments on 8/30/2022. A committee of one or more Aetna Better Health of Louisiana staff will review your case. The committee may include a licensed doctor or peer reviewer. The committee will not include anyone that is involved in your complaint. A decision will be made by 11/28/2022. and a letter will be mailed to you telling you each reason for the decision, At any time during the grievance process, you can have someone you know represent you or act ‘on your behalf. This person will be "your representative.” If you decide to have someone represent you or act for you, tell us in writing, the name of that person and how we can reach him or her. You or your representative may ask us to see any information we reviewed about your grievance. You may also send information that you have about your grievance to us at: Aetna Better Health of Louisiana Grievance System Manager PO Box 81139 5801 Postal Road Cleveland, Ohio 44181 1-855-242-0802 Fax: 1-860-607-7657 Phone: wy etterhealth.com/louisiana LA-14-10-17 Page 3 of 7 Issued: 02-01-2015 srs514t-19215514-10920 lad Ze22-0f-[g Signe] Zo22-OF-||_ Ose Aetna Better Health’ of Louisiana a ‘tre trea a 20 vaetna Kenner, LA 70062 If your grievance is described correctly at the top of this letter, please sign below and return this letter in the envelope provided. If your grievance is not described correctly, please call us at 1-855-242-0802. (Members and representatives with hearing impairments call Louisiana Relay 7-1-1) Need more help? If you have questions or need help with your grievance, including interpreter and translation services, at no cost to you call us at 1-885-242-0802 ) (Members and representatives with hearing impairments call Louisiana Relay 7-1-1) We will assign a staff person who has not been involved in your grievance issue to help you. Sincerely, Aetna Better Health of Louisiana ce: agree that my grievance is described correctly: Bry Blin 22-0 I-U_OIS ‘Membef or Member Representative Signature ywww.aetnabetterhealth.com/louisiana Page 4 of 7 Issued: 02-01-2015 LA-14-10-17