Banner Health and Aetna Health Plan Inc. claim denials in Arizona: the federal figures
Banner Health and Aetna Health Plan Inc. denied 17.8% of in-network claims in Arizona — 26,374 claims out of 148,205. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Banner Health and Aetna Health Plan Inc.) | 37 | 51.4% |
| External review (independent) | — | — |
What Banner Health and Aetna Health Plan Inc. denies most
The most common denial reason recorded for Banner Health and Aetna Health Plan Inc. plans in Arizona is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 16,614 | 36.4% |
| Service excluded from the plan | 11,135 | 24.4% |
| Benefit limit reached | 10,977 | 24% |
| Provider out of network | 3,568 | 7.8% |
| Referral required | 2,645 | 5.8% |
| Member not covered | 400 | 0.9% |
| Other reasons | 265 | 0.6% |
| Experimental or investigational | 77 | 0.2% |
| Not medically necessary | 11 | 0% |
What to do if Banner Health and Aetna Health Plan Inc. 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. Banner Health and Aetna Health Plan Inc. overturned 51.4% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Banner Health and Aetna Health Plan Inc.. 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 Banner Health and Aetna Health Plan Inc. 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 Banner Health and Aetna Health Plan Inc.'s denial rate high?
17.8% 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 Banner Health and Aetna Health Plan Inc. ignore the external decision?
No. External review decisions are binding on the plan.