Aetna denied it. Here is how the appeal works, and your 180-day deadline.
Put in the date on your Aetna notice and get both federal deadlines as calendar dates.
Free, for an Aetna denial, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
That date runs from the day printed on the notice, not the day you opened it, and if your employer pays the claims itself, your external review does not go to your state at all.
We read Aetna's appeal steps on August 25, 2026 and August 26, 2026. We quote them below. Neither page gives you your due date. The 180 days run from the date on your notice.
It's an error in Aetna's part. They can't legally require prior auth if you were admitted through the ER.
If Aetna denied a claim of yours, two dates matter more than any percentage. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
You are not alone, measured rather than said: 84,502,749 in-network claims were denied in a single plan year, and only 5,881 of them, one in 14,369, ever reached the independent review stage. Of the ones that did, 32.8% were overturned.
- Find the reason code on your denial letter. The notice has to state the specific reason and the plan provision behind it. Copy the code and the wording onto a piece of paper tonight, that sentence is what your appeal has to answer.
- Ask Aetna for the clinical criteria they judged you against. Under 29 CFR 2560.503-1 they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.
- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. Nationally only 1 in 14,369 denials ever reaches the second stage, and that is a deadline problem far more often than an argument problem.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How Aetna says an appeal works, in its own words
We read both sources and quote each line as written. Each is labeled provider or member. The provider source's decision clock, 60 calendar days, is never the member's clock. Member clocks differ by plan design. Your plan brochure or Summary Plan Description sets yours.
Who files which dispute
Aetna splits disputes into a reconsideration step and an appeal step, and reserves the member appeal process for pre-service and concurrent medical-necessity decisions.
| Dispute (Aetna's wording) | Route |
|---|---|
| Claims payment dispute (reimbursement, coding) | Provider reconsideration, then provider appeal |
| Pre-service or concurrent medical necessity decision | Member appeal process |
Provider process: from Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
The steps and the clocks, quoted
- Provider process. Dispute filing window: 180 days from the initial decision. “You have 180 days from the date of the initial decision to submit a dispute.” Note: State law can extend it: 'To the extent that our policy varies from the applicable laws or regulations of an individual state, the requirements of the state regulation supersede our policy.' From Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
- Provider process. Appeal decision timeframe: 60 calendar days. “We will notify you of our appeal decision in writing within 60 calendar days of our receipt of the appeal.” From Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
- Provider process. Two-level structure: reconsideration, then appeal. “Following reconsideration, if the decision is not in your favor, you may initiate an appeal.” From Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
- Provider process. Submission routes: provider portal, the PO box on the EOB, or fax. “Write to the P.O. box listed on the EOB statement … Fax the request to 1-866-455-8650” Note: The EOB in hand carries the correct address — there is no single national PO box. From Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
- Provider process. Member appeal scope: pre-service and concurrent medical-necessity decisions. “The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions.” From Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), checked August 25, 2026.
- Member process. Member appeal filing window: 180 days from the denial notice. “You have 180 days to appeal from when you get notice of the denied claim, unless your plan brochure (or Summary Plan Description) gives you more time.” Note: Member-side second source, on Aetna's own domain. Same page confirms the provider dispute window: 'Providers usually have 180 days after a claim denial to submit a dispute.' From Claim denial resources for members (aetna.com, undated page; fetched via browser — aetna.com blocks automated readers), checked August 26, 2026.
- Member process. Member submission routes: phone (number on ID card) or mail to the address on the EOB. “Phone: Call Aetna® Member Services at the number on your member ID card. Mail: Send your appeal to the address on your EOB. Or print and mail our form.” From Claim denial resources for members (aetna.com, undated page; fetched via browser — aetna.com blocks automated readers), checked August 26, 2026.
- Member process. Second-level review window (two-appeal plans): 60 days from the appeal decision letter. “You can ask for a second review within 60 days from the date of the appeal decision letter.” Note: Member decision clocks differ by plan design: one-appeal plans decide in 30 days pre-care / 60 days otherwise; two-appeal plans in 15 / 30. Urgent: 72 hours (one-appeal) or 36 hours (two-appeal). The provider source's flat 60-day clock is the provider process, not this one. From Claim denial resources for members (aetna.com, undated page; fetched via browser — aetna.com blocks automated readers), checked August 26, 2026.
Sources: Aetna, Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers), on www.banneraetna.com, written for health care providers, checked August 25, 2026. Aetna, Claim denial resources for members (aetna.com, undated page; fetched via browser — aetna.com blocks automated readers), on www.aetna.com, written for members, checked August 26, 2026. Checked August 25, 2026, the provider source is a copy on www.banneraetna.com, not a page on www.aetna.com.
Your two dates
The free deadline calculator turns your Aetna notice date into a 180-day date and a 4-month date. Both are federal clocks. If your plan gives more than 180 days, your letter is the authority.
Two dates decide more of this than anything else, and neither is on the front of your letter in a way anyone notices. Work them out tonight, write them on the letter itself, and you have already done the part that is easiest to lose. If your dates are strange, a denial that arrived after the treatment, or a letter with no external-review instructions on it at all, send me the wording with the identifying details removed and I will tell you which clock you are on.
, Andrew at Axion Labs · hello@getaxionlabs.comNo account, no email, no card. Both federal deadlines dated from your notice, and the body that decides your case at the end.
We read every Aetna line here on the 2 pages named above. None of them is a figure from the file below.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).