aetnafirst-appealstrategy
Aetna Denial: How to Win Your First Appeal
March 15, 2026
9 min read
Aetna, now part of CVS Health, is one of the largest health insurers in the US. If Aetna has denied your claim, here's how to win your first appeal.
Aetna's Appeal Process
Aetna has a two-level internal appeal process:
1.**First-Level Appeal**: Reviewed by someone not involved in the original denial
2.**Second-Level Appeal**: Additional review with new clinical reviewers
After exhausting both levels, you can request an external review.
Key Aetna Contact Information
•Appeals: P.O. Box 14079, Lexington, KY 40512
•Phone: 1-888-632-3862
•Fax: 1-860-754-5440
•Email: appeals@aetna.com
Winning Strategy for Aetna Appeals
1.**Reference their CPBs**: Aetna publishes Clinical Policy Bulletins. Request the specific CPB used in your denial.
2.**Address each criterion**: Your appeal should address every point in the CPB that you allegedly didn't meet.
3.**Peer-reviewed literature**: Aetna responds well to published medical evidence.
4.**ERISA compliance**: If employer-sponsored, cite ERISA full and fair review requirements.
Case Law: Davis v. Aetna (2024)
In Davis v. Aetna (3d Cir. 2024), the court held that emergency services cannot be denied for lack of pre-authorization, awarding $32,000.