Over Payment

Attention Providers: The following page includes information on our recovery of overpayment process.

Aetna Senior Supplemental Insurance* does not recoup, retract, or offset refunds.

In order to submit your refund check and receive a refund request letter please fill in the following required fields and click "Submit" at the bottom of the page. Please note that all fields must be completed in order to process your request. Once the completed form is received, we will send a letter confirming that we are awaiting the return of funds for the overpayment you have identified.

Patient's name:

Policy number:

Claim number:

Date of service:

Overpayment amount: $

Reason for refund:

Other comments:

Provider name:

Provider's address to mail the request letter:

Provider address Line 1:

Provider address Line 2:

Provider city:

Provider state:

Provider zip:

Provider tax ID number:

Provider phone number:

Requested by:

Provider email:

Refunds can be mailed to the address below, and should include the check and a copy of the Explanation of Benefits (EOB):

Normal mail
PRS - Payment Resolution Services
Attn. MSC 410837
PO Box 415000
Nashville TN, 37241-0837

Fed Ex or UPS
PRS - Payment Resolution Services
MSC 410837
301 Donelson Pike
Nashville TN, 37214

For questions regarding overpayment of recovery you can contact the Overpayment Team at Payment Resolution Services (PRS) at the contact information below Monday through Friday, 8:00 AM to 4:25 PM CT.

Phone: 1-800-325-5340 (TTY: 711)
Fax: 1-855-213-5830
Language Line: 1-866-699-9328
Payment Line: 1-615-472-9204

*The following companies are either owned by Aetna and/or have Medicare Supplement policy administration by Aetna and its affiliates (Aetna Senior Supplement Insurance):

Accendo Insurance Company, part of the CVS Health family of companies and Aetna affiliate
Aetna Health and Life Insurance Company
Aetna Life Insurance Company
Aetna Health Insurance Company
Allianz Life Insurance of New York
American Continental Insurance Company
American General Life and Accident Insurance Company
Combined Insurance Company of America
Continental Life Insurance Company of Brentwood, Tennessee
Coventry Health and Life Insurance Company
First Health Life and Health Insurance Company
Genworth Life and Annunity Insurance Company
Genworth Life Insurance Company
SilverScript Insurance Company (Medicare Supplement only), a CVS Health company and Aetna affiliate
Union Fidelity Life Insurance Company
Virginia Surety Company, Inc.
Washington National Insurance Company

Form ID: CGFLP02534 / Version: 040526

Overpayment Refund Request