Aetna Denied Your MRI Scan?
Aetna (CVS Health) denies 16.7% of claims on average. But 49% of appeals succeed when patients fight back. Your mri scan denial may have grounds for a successful appeal.
Why Aetna Denies MRI Scan
Prior authorization required but not obtained
Deemed not medically necessary at this stage
Lower-cost imaging (X-ray, CT) not tried 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 MRI Scan Appeal
Clinical notes explaining why MRI is specifically needed over other imaging
Documentation of symptoms warranting urgent imaging
Peer-to-peer review between ordering physician and insurer medical director
Laws That Protect You
ACA §2719 — Right to appeal imaging denials
No Surprises Act — Protection against balance billing
State laws requiring timely authorization decisions
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 MRI 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.