Appeal a Aetna MRI Denial (Code 151)
47% of these denials are overturned on appeal (n=56,180)
Aetna is counting on one thing: that you will not push back before the deadline. The denial letter is written to make you give up. The data says appealing is worth it. Denials of this type are overturned about 47% of the time on appeal (n=56,180, external-review records, 2026).
Aetna denied a MRI claim with code 151 (medical necessity). Information submitted does not support this many or this frequency of services.
Denials of this type are overturned about 47% of the time on appeal (n=56,180, external-review records, 2026).
Your move: appeal citing Aetna's coverage policy for MRI plus the federal rule governing your plan.
Expert analysis: how this denial is overturned
A medical necessity denial means the plan agrees the service exists and is covered in principle but decided that, in your specific case, it was not clinically warranted. In practice the plan applied an internal coverage guideline and concluded your records did not meet it. For employer and ACA plans, the appeal is governed by 29 CFR 2560.503-1(h)(1), which guarantees a full and fair review, and by 29 CFR 2560.503-1(g)(1)(v), which entitles you to the exact rule, guideline, or criterion the plan used. Demand that criterion first, then rebut it point by point with chart notes, failed prior treatments, and a physician letter mapping your findings to each element. You generally have at least 180 days to appeal (29 CFR 2560.503-1(h)(3)(i)). If the internal appeal fails, medical-judgment denials qualify for independent external review under 45 CFR 147.136(d)(1)(i)(A). Honest odds: Apellica overturns 47% of appealed medical-necessity denials (n=56,180).
Sources: 29 CFR 2560.503-1 (ERISA claims procedure), 45 CFR 147.136 (ACA internal and external review), and the X12 Claim Adjustment Reason Code standard.
Don't write off a bill you can appeal
A senior reviewer reads your file and we prepare and file the appeal for you. You pay nothing upfront, and only if your appeal wins.
Appeal my Aetna MRI denialFrequently asked questions
- What does denial code 151 mean?
- Information submitted does not support this many or this frequency of services.
- Is denial code 151 appealable?
- Yes. Denials of this type are overturned about 47% of the time on appeal (n=56,180, external-review records, 2026).
- What should I send to appeal a code 151 denial?
- Supply the missing element for this code, a short appeal letter citing the plan's claims-procedure rules, and any clinical support. Apellica prepares and files this for you.