Insurer · Aetna
How we file an Aetna appeal.
The procedure we follow on an Aetna bill — where the errors usually hide, and the codes and laws we cite.
Aetna appeal procedure
Aetna requires the appeal to be filed within 180 days of the original EOB date for ERISA plans (60 days for non-ERISA), submitted via member portal upload, fax, or certified mail. They issue a written decision within 30–60 days depending on plan type. External review is available after the second-level internal appeal.
Most common findings on Aetna bills
- ER E/M upcoding (99284 vs 99285)
- Unbundled radiology (TC + 26 modifiers billed separately when bundled per CPT)
- Out-of-network anesthesia at in-network hospitals (NSA-protected)
What we cite in Aetna appeals
- Aetna Clinical Policy Bulletins (procedure-specific)
- AMA CPT Manual
- Federal No Surprises Act, 2022
- ERISA §503 procedural requirements
Got an Aetna bill that looks wrong?
Start with the EOB and the provider’s itemized bill. The public site routes you to a free human audit instead of claiming an instant result.
Try the auditOther insurers: Blue Cross Blue Shield · UnitedHealthcare