How to appeal a denial from Aetna

UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE

Aetna is part of CVS Health and covers employer plans, ACA marketplace plans in some states, and a large Medicare Advantage book. Medical appeals go to Aetna; drug denials usually run through CVS Caremark, Aetna's pharmacy benefit manager, on a separate track.

How appeals work at Aetna

• Submit medical appeals through your Aetna member account or by mail to the address in your denial letter's appeal-rights section.
• Prescription denials are typically handled by CVS Caremark — the drug denial notice has its own exception and appeal instructions, and your prescriber can file the exception request for you.
• Aetna commonly offers two internal appeal levels on employer plans — the letter states how many you get and the deadline for each.
• For urgent care denials, ask explicitly for an expedited appeal — federal rules require a decision within roughly 72 hours when your health is in jeopardy.

The deadlines that apply to nearly every Aetna plan

• At least 180 days to file the internal appeal from the date on the denial notice (non-grandfathered plans; the date printed on your letter controls).
• The plan must decide within about 30 days for care you haven't received yet, and about 60 days for care already received.
• Urgent case? Ask for an expedited appeal — a decision in roughly 72 hours when a physician confirms that waiting endangers your health.
• After the final internal denial: you can request independent external review — generally within about 4 months, per your letter.
• Employer self-funded plan? ERISA rules apply: state programs and regulators generally don't, and external review runs through the federal process. Your letter or HR can confirm the funding type.

Federal sources: HealthCare.gov internal appeals and HealthCare.gov external review. Your denial notice and plan documents control when they differ.

Best next reads: Formulary / drug-not-covered denials and Step therapy denials — and decode any codes on the letter in the denial-code library.

Common questions

My medication was denied — do I appeal to Aetna or CVS Caremark?

Check the letterhead of the denial notice. Pharmacy denials usually come from (and are appealed to) CVS Caremark as the pharmacy benefit manager, and formulary exception requests can be started by your prescriber. Medical service denials are appealed to Aetna itself.

How many internal appeals do I get with Aetna?

It depends on your plan — many employer plans include two internal levels, marketplace plans often one. Your denial letter must state your appeal levels and the deadline for each; after the final internal denial you can request independent external review.