How to appeal an Aetna denial
Aetna runs reconsideration and appeal as consecutive windows — 180 days for the first, then a fresh 60 days that only starts when the reconsideration decision lands.
Deadlines
These are the windows Aetna publishes. They vary by contract, product line and state — so treat the date on your remittance advice as the one that governs.
- Reconsideration filing
- commonly 180 calendar days from the initial claim decision
- State regulations or your organizational provider contract may allow more time.
- Appeal filing
- commonly 60 calendar days from the reconsideration decision
- This window is consecutive, not concurrent — it starts when the reconsideration decision is issued.
- Aetna's response
- commonly 60 business days
- Measured from receipt, or from receipt of any additional information the specialty unit requested.
The appeal path
- 01
Reconsideration
The first-level review of the claim decision. Most payment disputes start and many end here.
- 02
Appeal
Filed after the reconsideration decision. This window opens when that decision is issued, not when the original claim was denied.
- 03
External review
Where applicable by product and state, after internal levels are exhausted.
Where to submit
- The Aetna provider portal (Availity) for most disputes
- The dispute and appeal forms Aetna publishes for its provider site
- The address on the remittance advice, where a written submission is required
What to include
- The remittance advice showing the decision being disputed
- The reconsideration decision, when filing the second-level appeal
- Documentation addressing the specific denial reason
- The claim as submitted
What catches practices out
- The two windows run consecutively. It is not 240 days from the denial — the 60-day appeal clock does not exist until the reconsideration decision is issued.
- Because response times run in business days while filing windows run in calendar days, the real calendar gap is longer than it looks. Calendar both.
- State regulations override the plan-level standard in some markets, sometimes in your favor. Worth checking before conceding a missed window.
Common questions
- How long do I have to appeal an Aetna denial?
- Aetna's provider material describes roughly 180 calendar days from the initial claim decision to file a reconsideration, then roughly 60 calendar days from the reconsideration decision to file the appeal. State rules or your contract may allow more.
- Is it 240 days in total?
- No, and assuming so is the common way these are missed. The windows are consecutive: the 60-day appeal clock starts only when Aetna issues the reconsideration decision, so a slow reconsideration does not shorten your appeal window — but a fast one does not lengthen it either.
- What if I missed the reconsideration window?
- Check whether state regulation or your organizational contract allows more time than the plan standard — in some markets it does. That is worth confirming before treating the claim as closed.
Draft the Aetna appeal in about three minutes
Upload the denial. Undeny reads it, drafts an appeal letter built around the denial code and the record, and tracks the deadline until the money comes back.