Aetna Denied Your CT Scan?
Aetna (CVS Health) denies 16.7% of claims on average. But 49% of appeals succeed when patients fight back. Your ct scan denial may have grounds for a successful appeal.
Why Aetna Denies CT Scan
Not medically necessary based on clinical criteria
MRI recommended instead of CT
Prior imaging not attempted first
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 CT Scan Appeal
Physician order with clinical indication
Evidence that CT is more appropriate than MRI for the condition
ACR Appropriateness Criteria supporting CT for diagnosis
Laws That Protect You
ACA — Preventive screening requirements
State imaging parity laws
Emergency prudent layperson standard
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 CT Scan 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.