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Aetna — Denial Rates & Appeal Data

Name: Aetna prior authorization denial metrics
Creator: Coverage Rights

Medicare AdvantageMedicaid MCOCommercialReporting year 2025

Compare against every insurer we track: denial rates ranked within reporting cohorts.

Prior-auth denial rate

7.6%

of Medicare Advantage medical-service contracts requests denied

Appeal overturn rate

88.8%

of appealed Medicare Advantage medical-service contracts denials reversed

COVERAGE RIGHTS ROLLUP · CALCULATED FROM AETNA PUBLIC DISCLOSURES

Aetna publishes per-contract percentages only (42 Medicare Advantage contracts, medical services excluding drugs; no request counts). Rates shown are enrollment-weighted averages of Aetna's own posted per-contract figures across 40 contracts covering ~4.2M enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 2 contracts lacked published enrollment). Standard denial rates range 0–19.9% across contracts; the appeal overturn figure is Aetna's standard-track "approved after appeal" rate, weighted the same way across the 39 contracts reporting it.

UNDERLYING SOURCE: AETNA CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY

Metrics by contract / plan

Aetna’s own CY2025 CMS-0057-F disclosures, plan by plan. Standard-request figures; every row links to its source.

Aetna CY2025 prior authorization metrics by contract or plan
Contract / plan	Line	Requests	Denied	Appeals overturned	Avg decision	Source
H9431	Medicare Advantage	n/r	19.86%	93.75%	2.67d	Source
H5309	Medicare Advantage	n/r	16.34%	95.37%	2.71d	Source
H8332	Medicare Advantage	n/r	13.18%	72.22%	1.46d	Source
H4523	Medicare Advantage	n/r	12.73%	88.96%	1.8d	Source
H8597	Medicare Advantage	n/r	12.65%	86.35%	1.79d	Source
H3219	Medicare Advantage	n/r	11.47%	80.43%	2.28d	Source
H4711	Medicare Advantage	n/r	11.3%	86.71%	1.93d	Source
H3288	Medicare Advantage	n/r	10.94%	90.48%	1.66d	Source
H4835	Medicare Advantage	n/r	10.69%	88.46%	1.81d	Source
H3928	Medicare Advantage	n/r	10.42%	87.1%	1.54d	Source
H3239	Medicare Advantage	n/r	10.41%	84.71%	1.69d	Source
H1609	Medicare Advantage	n/r	10.36%	83.79%	1.5d	Source
H8649	Medicare Advantage	n/r	10.17%	90.34%	1.93d	Source
H1692	Medicare Advantage	n/r	9.59%	90.69%	1.47d	Source
H3931	Medicare Advantage	n/r	9.5%	87.93%	1.68d	Source
H3192	Medicare Advantage	n/r	9.37%	85.3%	1.6d	Source
H5325	Medicare Advantage	n/r	8.68%	83.73%	1.47d	Source
H2293	Medicare Advantage	n/r	8.29%	88.86%	1.53d	Source
H1608	Medicare Advantage	n/r	8.17%	92.4%	1.45d	Source
H5521	Medicare Advantage	n/r	7.86%	89.7%	1.44d	Source
H7149	Medicare Advantage	n/r	7.76%	88.55%	1.53d	Source
H0628	Medicare Advantage	n/r	7.68%	89.47%	1.28d	Source
H1109	Medicare Advantage	n/r	7.68%	82.61%	1.39d	Source
H5302	Medicare Advantage	n/r	7.44%	85.65%	1.29d	Source
H3312	Medicare Advantage	n/r	7.31%	82.33%	1.3d	Source
H3748	Medicare Advantage	n/r	7.28%	90.62%	1.47d	Source
H2056	Medicare Advantage	n/r	7.22%	88.46%	1.5d	Source
H3146	Medicare Advantage	n/r	7.09%	86.28%	1.33d	Source
H5593	Medicare Advantage	n/r	7%	85.71%	1.36d	Source
H5522	Medicare Advantage	n/r	6.97%	90.32%	1.28d	Source
H2663	Medicare Advantage	n/r	6.77%	90.12%	1.24d	Source
H5337	Medicare Advantage	n/r	6.59%	n/r	0.86d	Source
H3959	Medicare Advantage	n/r	6.05%	87.59%	1.11d	Source
H7301	Medicare Advantage	n/r	6.02%	89.77%	1.21d	Source
H1206	Medicare Advantage	n/r	5.96%	87.18%	1.17d	Source
H5793	Medicare Advantage	n/r	5.78%	86.22%	1.13d	Source
H3152	Medicare Advantage	n/r	5.5%	81.2%	1.06d	Source
H3597	Medicare Advantage	n/r	5.46%	91.25%	1.15d	Source
R6694	Medicare Advantage	n/r	5.46%	94.74%	0.96d	Source
H0523	Medicare Advantage	n/r	2.39%	53.33%	3.06d	Source
H4982	Medicare Advantage	n/r	2.04%	56.58%	2.3d	Source
H0562	Medicare Advantage	n/r	0%	n/r	2d	Source

N/R = NOT REPORTED · COLLECTED 2026-07-19 FROM AETNA’S PUBLISHED DISCLOSURES

What these numbers mean for your denial

Coverage Rights calculated a 7.6% prior-authorization denial rate for the Medicare Advantage medical-service contracts in 2025. In the calculated Medicare Advantage medical-service contracts appeal scope, 88.8% were reversed — most denials that got challenged did not survive review. The underlying contract or plan figures were published by Aetna; Coverage Rights performed the stated rollup.

The practical takeaway is narrower: an initial denial can change on review. These aggregate rates describe past decisions within the stated reporting scope; they do not predict the result of an individual appeal.

Your appeal deadline depends on your plan type

Aetna runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:

Medicare Advantage appeal rights Medicaid appeal rights Employer plan (ERISA) appeal rights

Common questions

What is Aetna's prior authorization denial rate?

Coverage Rights calculated a 7.6% prior-authorization denial rate for the Medicare Advantage medical-service contracts reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage medical-service contracts appeal scope, 88.8% were overturned.

How do I appeal a Aetna denial?

Start with the appeal instructions in Aetna's denial notice. An independent external, fair-hearing, or Medicare review may be available after the required internal review, but eligibility depends on the coverage program, plan funding, denial type, regulating jurisdiction, and whether the notice says internal review is exhausted. Use the pathway tool before choosing the next reviewer.

Where do these numbers come from?

Coverage Rights calculated the displayed rollup from Aetna's public CMS-0057-F disclosures for 2025. The methodology note identifies the included reporting scope and weighting or aggregation method; source links lead to the underlying insurer-published records.

Denied by Aetna? 88.8% were overturned in the Coverage Rights rollup of the Medicare Advantage medical-service contracts scope. Build an evidence-backed appeal.

How to appeal Start my appeal