Insurer Appeal Playbook
How to Appeal a Aetna / CVS Health Denial
Aetna / CVS Health denied 8% of standard prior-authorisation requests in calendar year 2025 and overturned 89% of those denials upon provider appeal (KFF analysis of CMS-0057-F insurer disclosures, August 2026).
Published Overturn Rate:
89%
PA Denial Rate: 8%
Verified: Quarter 3, 2026
Aetna / CVS Health Appeal Levels & Timely Filing Windows
Stage 01
Reconsideration / Peer-to-Peer
Deadline: 180 days from remittance
Format: Online via Availity or formal appeal form
Stage 02
Formal Level 2 Appeal
Deadline: 60 days from Reconsideration notice
Format: Comprehensive clinical record package
Winning Appeal Tactics for Aetna / CVS Health
Always quote the exact Aetna Clinical Policy Bulletin (CPB) number in paragraph 1
Attach peer-to-peer discussion summaries when available
Most Common Aetna / CVS Health Denial Triggers
01. CO-16 (Missing modifier/info)
02. CO-50 (Clinical policy bulletin exception)
03. CO-97 (NCCI edit)
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