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.

Aetna (CVS Health)

Also known as: Aetna, CVS Aetna, CVS Health

EmployerIndividualMedicare AdvantageMedicaid

Common Denial Patterns

Medical necessity denials citing Clinical Policy Bulletins
Step therapy enforcement for specialty medications
Prior authorization denials for outpatient procedures
Behavioral health denials (check Mental Health Parity)

Appeal Best Practices

1Reference the specific Aetna CPB number and section
2Include clinical guidelines that differ from Aetna criteria
3For behavioral health denials, explicitly cite MHPAEA
4Request the qualifications of the reviewer who denied the claim

Known Weaknesses

CPBs can be more restrictive than clinical consensus — cite broader evidence
Behavioral health reviews may not meet Mental Health Parity requirements
Aetna merged with CVS — pharmacy benefits may have conflicts of interest for drug denials

Contact & Response

Best Contact Method

Member portal > Fax > Mail

Typical Response Time

30 days (internal), 45 days (external)

Internal Criteria Used

Aetna Clinical Policy Bulletins (CPBs)
MCG

General Tips

Aetna publishes Clinical Policy Bulletins (CPBs) — reference the specific CPB
Aetna uses both MCG and internal criteria for medical necessity
Online appeal submission available through member portal
Aetna has a dedicated clinical appeals team

Have a denial from Aetna (CVS Health)?

Upload your denial letter for free analysis. Lysco uses Aetna (CVS Health)-specific intelligence to identify weak points and draft your appeal.

Upload Your Denial — Free

This information is for educational purposes based on publicly available data including CMS reports, state insurance department filings, and published insurer guidelines. It does not constitute legal, medical, or financial advice. Individual results vary. Verify all information independently and consult qualified professionals before acting.