Aetna Denied Your Mental Health Treatment?
According to federal data, Aetna (CVS Health) denies approximately 16.7% of claims. When patients appeal, about 49% are overturned. Your mental health treatment 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 Mental Health Treatment
Session limits or visit caps
Not medically necessary per reviewer assessment
Provider not in-network
Diagnosis not covered under plan
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 Mental Health Treatment Appeal
Cite MHPAEA — mental health must be covered at parity with medical/surgical
Document treatment necessity from psychiatrist or psychologist
Show that denial applies stricter criteria than comparable medical treatment
File with DOL if ERISA plan violates parity requirements
Laws That Protect You
Mental Health Parity and Addiction Equity Act (MHPAEA)
ACA Essential Health Benefits — Mental health is required
State mental health parity laws
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 Mental Health Treatment 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.