Aetna Denied Your CT Scan?
Published data shows denial and appeal outcomes vary by plan, product year, denial reason, and documentation. Use this page to spot the issues to request and the evidence to gather before you decide what to submit.Sources include KFF ACA Marketplace Transparency Data, HHS OIG reports, and state insurance department filings. Aggregate rates are context, not predictions for an individual case.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
Why they said no
Why Aetna Denies CT Scan
Not medically necessary based on clinical criteria
MRI recommended instead of CT
Prior imaging not attempted first
Aetna patterns
Aetna's Common Denial Patterns
Citing lack of medical necessity without reviewing full records
Applying step therapy requirements retroactively
Using internal guidelines stricter than Medicare standards
What works
How to Strengthen 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
Your rights
Laws That Protect You
ACA — Preventive screening requirements
State imaging parity laws
Emergency prudent layperson standard
Playbook
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
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Related denial guides
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CT Scan denials by other insurers
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.