Aetna Denied Your Cancer Treatment?
Aetna (CVS Health) denies 16.7% of claims on average. But 49% of appeals succeed when patients fight back. Your cancer treatment denial may have grounds for a successful appeal.
Why Aetna Denies Cancer Treatment
Treatment classified as experimental or investigational
Not following insurer-preferred treatment protocol
Out-of-network oncologist required for specialized care
Aetna's Common Denial Tactics
Citing lack of medical necessity without reviewing full records
Applying step therapy requirements retroactively
Using internal guidelines stricter than Medicare standards
How to Win Your Cancer Treatment Appeal
NCCN guidelines supporting the treatment protocol
Peer-reviewed studies and clinical trial results
Oncologist letter with detailed treatment rationale
FDA approval documentation for the specific indication
Consider attorney involvement for high-value cancer treatment denials
Laws That Protect You
ACA — Cancer screening and treatment as Essential Health Benefits
State cancer treatment mandate laws
Clinical trial coverage requirements (ACA §2709)
Tips for Appealing to Aetna
Request the specific clinical criteria used to deny your claim
Ask for a peer-to-peer review between your doctor and their medical director
File with your state insurance department if internal appeal fails
Ready to Fight Your Cancer Treatment Denial?
Upload your denial letter and get an AI-powered analysis in minutes. We'll identify the weaknesses in Aetna's reasoning and build your appeal strategy.
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.