Aetna Appeal Help
Aetna Denied Your Claim? How to Appeal
Your Aetna plan type sets your appeal deadline and route; your denial letter states both.
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Quick Answer
To appeal an Aetna denial, answer the Clinical Policy Bulletin your denial cites, point by point. Employer and individual plans must give you at least 180 days to appeal (29 CFR 2560.503-1; 45 CFR 147.136), followed by an independent external review; Medicare Advantage plans give you 60 days (42 CFR 422.582). AppealArmor drafts the appeal letter from your denial letter, free, and lists who to copy.
Which Aetna plan do you have?
Your plan type decides the rules, the deadline and where you complain. It is printed on your member card and your denial letter.
Employer plan
Federal claims rules apply (29 CFR 2560.503-1): you have at least 180 days from receiving the denial to appeal to Aetna, then an independent external review. Complaints go to your state insurance department for an insured plan, or the U.S. Department of Labor’s EBSA for a self-funded plan.
Individual or marketplace plan
The same 180-day minimum applies (45 CFR 147.136), followed by an independent external review. Complaints go to your state insurance department.
Medicare Advantage plan
Ask Aetna to reconsider within 60 days of receiving the notice (42 CFR 422.582); if Aetna upholds a denial of care it must send your case to an independent review entity (42 CFR 422.590). Complaints go to 1-800-MEDICARE (1-800-633-4227), not your state insurance department.
Medicaid plan
Appeal to Aetna within 60 days of the date on the notice (42 CFR 438.402(c)(2)(ii)), then ask your state Medicaid agency for a fair hearing if Aetna upholds the denial: you have 90 to 120 days from the plan’s appeal decision, depending on your state (42 CFR 438.408(f)(2)); the plan’s decision letter states your deadline.
How to build an Aetna appeal
Answer the Clinical Policy Bulletin
Aetna publishes Clinical Policy Bulletins that set its coverage criteria. Ask for the one your denial relied on and show, criterion by criterion, how your records meet it.
Ask who reviewed your case
For a medical-necessity denial, ask Aetna to confirm that a reviewer with appropriate training and experience in the field reviewed your complete record (29 CFR 2560.503-1(h)(3)(iii) for employer plans), and ask for the reviewer’s credentials.
Drug denials and step therapy
If Aetna requires step therapy, check whether your state has a step-therapy exception law for state-regulated plans, and whether you already tried the required drug, would be harmed by it, or are stable on your current one. CVS Health, which owns Aetna since 2018, also owns the CVS Caremark pharmacy benefit manager; in an employer plan, a structural conflict of interest is a factor courts weigh (Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (2008)).
Mental health and substance use denials
Ask for the plan’s comparative analysis of its nonquantitative treatment limitations under the federal parity law (29 CFR 2590.712), and compare it with how Aetna treats medical and surgical care.
How AppealArmor Fights Your Aetna Denial
Upload Your Aetna Denial Letter
Upload the denial letter from Aetna. AppealArmor reads the denial reason, plan details and appeal deadline, and you confirm every detail before anything is written.
We Find the Federal Rules for Your Plan
AppealArmor cites the federal appeal rules for your type of plan from the eCFR, plus state law where it applies, and names the agency that oversees your plan. It does not use insurer-specific research.
Download Your Appeal Packet
Your packet is the appeal letter (Word and PDF) and a Next Steps sheet: where to send it, your deadline as your letter states it, who to copy, and who to contact if it is denied again.
Frequently Asked Questions
How long do I have to appeal an Aetna denial?
Employer and individual plans must give you at least 180 days from receiving the denial (29 CFR 2560.503-1(h)(3)(i); 45 CFR 147.136). Medicare Advantage gives you 60 days (42 CFR 422.582), and Medicaid plans 60 days from the date on the notice (42 CFR 438.402(c)(2)(ii)). The deadline in your denial letter controls.
How do I appeal an Aetna denial?
Send Aetna a written appeal that answers the reason on the denial, with your doctor’s letter and records, and ask for an independent external review if Aetna says no again. AppealArmor drafts that letter and cites the federal appeal rules for your type of plan, plus state law where it applies. It does not use insurer-specific research.
Where do I complain about Aetna?
It depends on your plan: your state insurance department for an individual or insured employer plan, the U.S. Department of Labor’s EBSA for a self-funded employer plan, 1-800-MEDICARE for a Medicare plan, and your state Medicaid agency for a Medicaid plan. A complaint does not replace the appeal, so file both.
Does AppealArmor work for Aetna denials?
Yes. AppealArmor reads your Aetna denial letter, asks you to confirm every detail, and drafts an appeal letter that answers the stated reason and cites the federal appeal rules for your type of plan, plus state law where it applies. It does not use insurer-specific research, enforcement history or case law.
Appeal your Aetna denial
Upload your Aetna denial, check every detail we read from it, and get an appeal letter that answers the denial and cites the federal appeal rules for your plan, plus state law where it applies.
Start my appealFree, always. No account. You review every word before you send it — and we never send anything to your insurer. You do.