How to Appeal an MRI or Imaging Denial from Aetna

Imaging denied as "not medically necessary"? These denials are most often a documentation gap, not a coverage gap — which makes them very winnable.

Why MRI or imaging claims get denied

• "Not medically necessary" — usually means conservative treatment wasn’t documented
• Conservative therapy (physical therapy, medication, time) not shown to have been tried first
• The plan’s imaging criteria (often InterQual or MCG) weren’t addressed in the request

The argument that wins

• Most imaging denials are a documentation failure, not an eligibility failure. The records that win the appeal usually already exist — they just weren’t submitted with the original request.
• Assemble and submit the conservative-care record: weeks of physical therapy, NSAIDs or other medications, and the timeline of symptoms.
• Cite the plan’s own imaging criteria back to it, and have your physician document the red-flag symptoms or failed conservative care that justify imaging now.

Evidence to gather

• Physical therapy notes and dates
• Records of medications tried (NSAIDs, muscle relaxants) and duration
• The duration and progression of your symptoms
• Your physician’s clinical rationale for imaging now

Appealing with Aetna

Aetna appeals can usually be filed through your member account or by mail to the appeals address on your denial letter. You generally have 180 days to file an internal appeal, with expedited review available for urgent cases.

Whatever the channel, the argument is what wins — and that is the same regardless of insurer. Use the grounds above, attach the evidence, and file before your deadline.

Frequently asked questions