How do insurance denial appeals work?

Upload your denial letter and Lysco analyzes it, identifies the denial reason, cites applicable laws (ACA, ERISA, state regulations), and generates a customized appeal letter. You review and submit it yourself.

What is the success rate for insurance appeals?

It varies by plan type. For ACA marketplace plans, about 44% of appealed denials are overturned (KFF, 2023). For Medicare Advantage, it can be as high as 83% (HHS OIG). Many denials stem from billing or administrative errors that get fixed when challenged. Individual results vary.

Is Lysco a law firm or medical practice?

No. Lysco is an informational tool that helps you understand your rights and options. It is not a law firm, medical practice, or insurance company. For specific legal or medical situations, consult a licensed professional.

How much does Lysco cost?

Analysis is always free and your first appeal letter is free too. Upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited appeal letters, insurer playbooks, and benefits finder. Cancel anytime.

Is my health data secure on Lysco?

Yes. Lysco uses AES-256 encryption at rest, TLS for data in transit, and row-level security so only you can access your data. We never sell your data and follow HIPAA-aligned security practices.

Surgery Denial

Aetna Denied Your Surgical Procedure?

Aetna (CVS Health) denies 16.7% of claims on average. But 49% of appeals succeed when patients fight back. Your surgical procedure denial may have grounds for a successful appeal.

Analyze Your Denial Free Read the Appeal Guide

16.7%

Denial Rate

49%

Appeal Success

30-60 days

Typical Timeline

$10,000–$100,000+

Typical Claim

Why Aetna Denies Surgical Procedure

Not medically necessary — conservative treatment recommended

Prior authorization not obtained or expired

Procedure classified as cosmetic or elective

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 Surgical Procedure Appeal

Surgeon letter of medical necessity with clinical justification

Documentation of failed conservative treatments

Peer-reviewed literature supporting the procedure

Pre-authorization documentation (if obtained but later denied)

Laws That Protect You

ACA §2719 — Internal and external review rights

ERISA §502(a) — Right to sue for denied benefits

No Surprises Act — Emergency surgery protections

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 Surgical Procedure 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.

Analyze My Denial Free

Analysis is always free. No credit card required.

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.