Aetna Life Insurance Company claim denials in Missouri: the federal figures
Aetna Life Insurance Company denied 16.7% of in-network claims in Missouri — 28,555 claims out of 171,086. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Aetna Life Insurance Company) | 17 | — |
| External review (independent) | — | — |
What Aetna Life Insurance Company denies most
The most common denial reason recorded for Aetna Life Insurance Company plans in Missouri is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 7,568 | 42.8% |
| Service excluded from the plan | 3,708 | 21% |
| Benefit limit reached | 2,823 | 16% |
| Provider out of network | 2,040 | 11.6% |
| Referral required | 1,033 | 5.8% |
| Member not covered | 228 | 1.3% |
| Other reasons | 170 | 1% |
| Experimental or investigational | 92 | 0.5% |
What to do if Aetna Life Insurance Company denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice.
- If they say no again, go external. An independent organization reviews it — not Aetna Life Insurance Company. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Aetna Life Insurance Company appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Aetna Life Insurance Company's denial rate high?
16.7% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Aetna Life Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.