How do I appeal a denied claim with Aetna, and what is the deadline?

Aetna's page says your Explanation of Benefits (EOB) tells you why a claim was denied. You have the right to ask for a review. That is an appeal [1]. You can start it two ways. Call Member Services at the number on your member ID card, or mail the appeal to the address on your EOB [1].

Aetna says you have 180 days to appeal from when you get notice of the denied claim. Your plan brochure may give you more time [1]. Your appeal should include the group name, your name, your member ID number, and any comments or records you want reviewed [1].

For plans with one appeal, Aetna says it decides within 60 days for most claims. If it must approve care before you get it, the time is 30 days [1]. For urgent care, you or your doctor can ask for a fast appeal. With one appeal level, the decision is due within 72 hours [1]. If the claim is still denied, you may be able to ask for an outside review [1][2].

Your plan brochure or Summary Plan Description and your EOB show the exact address, levels and dates for your plan. Medicare Advantage and Medicaid plans from Aetna use other rules — "Don't know yet" for those.