How to Appeal an Aetna Insurance Denial

Aetna, now part of CVS Health, covers millions of Americans. Understanding their specific appeal procedures, online tools, and clinical criteria can significantly improve your chances of overturning a denial.

Aetna Appeal Process

Internal Appeal

  • File within 180 days of denial
  • Submit via the member portal at aetna.com, by mail, or by fax
  • Aetna allows you to include new evidence not in the original claim
  • First-level and second-level internal appeals available

External Review

  • Available after internal appeals exhausted
  • File through your state insurance department or federal process for self-funded plans

Aetna-Specific Tips

  1. Aetna Clinical Policy Bulletins (CPBs) are publicly available at aetna.com — review the CPB for your service
  2. Precertification list: Check if your service requires precertification at aetna.com
  3. Aetna Navigator portal lets you track claims and appeal status online
  4. CVS integration: Pharmacy denials may involve CVS Caremark — appeal through both channels if needed
  5. Ask for a case manager for complex or ongoing treatment cases

Key Contact Information
DepartmentContact
Member Services1-800-872-3862
AppealsAddress on denial letter
Provider Services1-800-624-0756
| Website | aetna.com |

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Frequently Asked Questions

How do I find Aetna's clinical policy for my denied service?

Visit aetna.com and search for 'Clinical Policy Bulletins.' These documents outline exactly what criteria Aetna uses to determine medical necessity. Address each criterion in your appeal letter.

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