--- title: "Aetna denial appeal: the process and your 180-day date" url: "https://denialfacts.com/company/aetna" publisher: "Axion Labs — Denial Facts" checked: "2026-09-05" dataset_fixity: "sha256-9cffae4274375f80d5a1488092efb3f8bdeada10986c5d681280c66d73ef1363" --- # Aetna denied it. Here is how the appeal works, and your 180-day deadline. Your Aetna denial appeal: Aetna's steps, quoted and dated, and your 180-day and 4-month deadlines from your notice, free. ## Aetna, at the top of the page Aetna, the appeal process Your two dates, free Date on your denial notice Who pays your claims? A job, an insurance company pays the claims A job, my employer pays the claims itself (self-funded) A job, I do not know which Marketplace / individual plan I bought myself Medicare, Medicaid, TRICARE, VA or IHS Which state? The reason your letter gives I'm not sure, I'll paste the sentence later Not medically necessary Provider out of network Service excluded from the plan Experimental or investigational Referral required Benefit limit reached Member not covered Administrative reason Other reasons Show my two dates, free 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. We hear this most. [r/HealthInsurance, “Denied due to no pre authorization”](https://www.reddit.com/r/HealthInsurance/comments/1jpcblk/denied_due_to_no_pre_authorization/) , read September 3, 2026. By [Andrew at Axion Labs](/about) · August 19, 2026, updated September 5, 2026 No current Aetna denial rate in the 2026 file. The current [CMS Transparency in Coverage file](https://data.healthcare.gov/) , the plan-year 2026 release issued September 26, 2025 and read September 5, 2026, carries no Aetna reporting entity, so this page prints no Aetna denial rate. The clock your letter has to describe, in actual dates 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](https://www.ecfr.gov/current/title-29/section-2560.503-1) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) ) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), in plain English at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) , 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. Data verified September 5, 2026 · CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain 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. What to do tonight - 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](https://www.ecfr.gov/current/title-29/section-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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.aetna.com/individuals-families/member-rights-resources/claim-denials.html) , 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)](https://www.aetna.com/individuals-families/member-rights-resources/claim-denials.html) , 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)](https://www.aetna.com/individuals-families/member-rights-resources/claim-denials.html) , 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)](https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html) , 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)](https://www.aetna.com/individuals-families/member-rights-resources/claim-denials.html) , 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](/appeal-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.com [Show my two dates, free](/appeal-letter) No account, no email, no card. Both federal deadlines dated from your notice, and the body that decides your case at the end. Where these numbers come from 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](https://data.healthcare.gov/) . Rights and timeframes: [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) (180 days, and your free right to the claim file) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) (4 months, and what qualifies), explained at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . 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)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) and [govinfo.gov (45 CFR 147.136)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) . This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov. Problem solved: You have Aetna's process, labeled provider or member, and the 180-day date your appeal runs on. ## The pages that answer the next question - [If your employer pays the claims itself](/self-funded-denial) , then Aetna is only administering the plan, your state's external review has no power over the denial, and the route is federal. It is the first question our own calculator asks. - [If it was refused before the treatment](/prior-authorization-denied) , a prior-authorization refusal from Aetna runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you. - [Denial code CO-50 on the remittance](/denial-codes/co-50) , "not deemed a medical necessity" is the single most common category in the federal file, and it is the one Aetna has to show you the written criteria for. - [Before you pay a lawyer](/before-you-call-a-lawyer) , two free appeals run before anyone bills you by the hour, and Aetna has to hand you the claim file for nothing under 29 CFR 2560.503-1. - [All national brands ranked](/denial-rates-by-company) , the brands the current file carries enough volume to rank; Aetna is not among them. - [How both appeals work](/how-to-appeal) , the internal appeal, then the independent review whose decision binds the plan. Your dates are ready. [Write the letter, free](/appeal-letter) ## The two federal clocks The clock your letter has to describe, in actual dates Whatever else is on the page, these two dates are the page. 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. ## What is free here, and what the one paid thing costs Denied a claim? Insurers upheld 66% of the internal appeals people filed in 2024 ( KFF ). The win is at independent external review, and the only way to arrive there is to run the internal stage on time, in the right order, with the record intact. That sequence is what the Appeal Kit is. Get my Appeal Kit, $29 One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com. Get my Appeal Kit, $29 Everything you need for your appeal: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com. ## What we will not pretend What we will not pretend. We cannot overturn your denial. Only your plan, or an independent reviewer, can do that. We cannot make your plan cover a service it genuinely excludes. We cannot guarantee external review applies to your denial. It covers medical judgment, experimental or investigational determinations, and rescission, a purely administrative denial may not qualify, and we say so on those pages rather than selling you past it. We have no customer testimonials and publish none. Our evidence is the federal dataset and the regulation cites, both of which you can check. ## Every page on this site Home Start here Insurers By company States Denial reasons How to appeal Ranked by denial rate The external-review gap Write the letter, free Deadline calculator Self-funded plan? Prior authorization denied Denial code CO-50 Before you call a lawyer Attorney for a denied claim Your denial letter About How we compare Privacy Terms For machines: llms.txt openapi.json changes.json the composed answer this page as markdown ## Which release these figures are Which release these figures are Every number on this page is the plan-year 2026 Transparency in Coverage file, issued September 26, 2025, covering plan-year 2024 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2026. One CMS file does carry a later issue date: the plan-year 2025 release was issued September 30, 2025, four days after this one. That is the PRIOR plan year, not a newer release, we publish by plan year, and both files are listed at data.healthcare.gov . A test in this site’s build fetches that list on every run and fails if CMS publishes a later plan year. The two releases before this one, plan-year 2024 and plan-year 2025, are kept alongside it so the direction of travel is visible rather than a single year’s snapshot; /about says what changed between them. Across the three Transparency in Coverage releases CMS has published, external reviews filed rose from 2,336 to 5,881 while the share overturned fell from 44% in the plan-year 2024 release to 32.8% in the plan-year 2026 release. ## Where these numbers come from Where these numbers come from 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) . ## Who publishes this Denial Facts publishes federal data about health insurance claim denials. We are independent: not affiliated with, endorsed by, or acting for any insurer, government agency, or review organization. We are not a law firm, a medical provider, or an insurance producer, and nothing here is legal, medical, or insurance advice. Data: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Figures cover individual-market Qualified Health Plans on the federal Exchange and come from the plan-year 2026 release, issued September 26, 2025, covering plan-year 2024 claims, the newest plan year CMS has published. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2026. One CMS file does carry a later issue date: the plan-year 2025 release was issued September 30, 2025, four days after this one. That is the PRIOR plan year, not a newer release, we publish by plan year, and both files are listed. See where the data comes from . Other fights we cover: UK parking, appealsdesk.co.uk · NYC parking ticket, nycticketfacts.com · UK tax filing (Making Tax Digital), mtdfacts.co.uk · background check, screeningfacts.com . ## Sources - Dispute & Appeals Process (Aetna process as published by Banner|Aetna; aetna.com's own overview page blocks automated readers) (checked 2026-08-25): https://www.banneraetna.com/en/health-care-professionals/dispute-and-appeals-overview/dispute-and-appeals-process.html - Claim denial resources for members (aetna.com, undated page; fetched via browser — aetna.com blocks automated readers) (checked 2026-08-26): https://www.aetna.com/individuals-families/member-rights-resources/claim-denials.html - CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain: https://data.healthcare.gov/ - 29 CFR 2560.503-1 (180 days, and your free right to the claim file): https://www.ecfr.gov/current/title-29/section-2560.503-1 - 45 CFR 147.136 (4 months, and what qualifies): https://www.ecfr.gov/current/title-45/section-147.136 - HealthCare.gov on external review: https://www.healthcare.gov/appeal-insurance-company-decision/external-review/ Cite: Axion Labs — Denial Facts, "Aetna denial appeal: the process and your 180-day date", https://denialfacts.com/company/aetna (checked 2026-09-05). free to quote with the URL.