Aetna
A major U.S. health insurer, acquired by CVS Health in 2018. Central to vertical integrationVertical IntegrationA corporate structure in which a single entity owns multiple layers of the healthcare delivery chain — insurer, pharmacy benefit manager, pharmacy, and physician group — creating s… concerns: CVS simultaneously owns Aetna (insurance), CVS Pharmacy, and CVS Caremark (PBMPBM — Pharmacy Benefit ManagerA Pharmacy Benefit Manager (PBM) is the intermediary that administers prescription-drug benefits for health plans and employers — deciding which drugs a plan covers, negotiating re…).
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Denial Data — Aetna (CVS Health)
| Measure | 2023 | 2024 |
|---|---|---|
| ACA claim denial rate | 22% | — |
| ACA claims denied | 6.80M of 31.4M | — |
| MA prior auth denial rate | 11.0% | 11.9% |
| MA denials appealed | 16.8% | 19.9% |
| MA appeals overturned | 89.7% | 92.6% |
When Aetna Medicare Advantage denials were appealed in 2024, more than nine in ten were overturned — suggesting many of the original denials should not have been issued. CVS Health is not among the major Marketplace insurers in KFF’s 2024 data.
ACA = in-network claims on HealthCare.gov Marketplace plans. MA = Medicare Advantage prior authorization requests. Source: federal CMS data analyzed by KFF.
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