Aetna Denied Your CT Scan?
According to federal data, Aetna (CVS Health) denies approximately 16.7% of claims. When patients appeal, about 49% are overturned. Your ct scan denial may have grounds for a successful appeal.Sources: KFF ACA Marketplace Transparency Data, HHS OIG Reports, state insurance department filings. Rates are aggregate averages — individual results vary by plan type, denial reason, and documentation.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
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 Review Your CT Scan Denial?
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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.