Aetna (CVS Health) Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Aetna (CVS Health). Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 15-30 days standard, 72h expedited
- Appeals Address: Aetna Appeals, PO Box 14463, Lexington, KY 40512
- Provider Portal: https://www.aetna.com/health-care-professionals.html
Why Aetna Denies Prior Authorizations
- 1. Step therapy not completed
- 2. Missing documentation of failed first-line agents
- 3. Non-formulary alternative available
- 4. Site of care restriction
Clinician Tips for Aetna
- ✓ Always cite Aetna Clinical Policy Bulletin (CPB) number
- ✓ Include failed trials with dates and adverse events
- ✓ Use Aetna Provider Portal for electronic PA
Aetna publishes CPBs publicly; reference the exact bulletin number in your LMN.
Aetna Prior Authorization FAQ
Why does Aetna deny prior authorizations?
The most common Aetna denial reasons are: Step therapy not completed; Missing documentation of failed first-line agents; Non-formulary alternative available; Site of care restriction.
How long does Aetna take to review a prior authorization?
Aetna typically responds in 15-30 days standard, 72h expedited.
What should a Letter of Medical Necessity for Aetna include?
An LMN for Aetna (CVS Health) should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. Aetna publishes CPBs publicly; reference the exact bulletin number in your LMN.