Aetna Behavioral Health Appeals in Ohio
Appealing an Aetna behavioral health denial in Ohio means tracking two separate clocks: Aetna's own 30-day Level-1 appeal window, and Ohio's 30-day prompt-payment statute (Ohio Rev. Code § 3901.381) for clean-claim payment. This guide covers both, plus Aetna's filing address and Ohio's parity protections.
Where to file your Aetna appeal
PO Box 14020
Lexington, KY 40512
Ohio's prompt-payment window
In Ohio, state-regulated (fully-insured) plans — including many Aetna plans — generally must pay or formally respond to a clean claim within 30 calendar days under Ohio Rev. Code § 3901.381. This deadline does not bind self-funded ERISA plans. This is a claim-payment deadline, not the appeal-decision deadline. If Aetna missed this window on your claim, cite it as a separate payment violation alongside your Aetna appeal — not as the deadline for the appeal decision itself.
A third-party payer pays or denies a claim submitted on the standard claim form within 30 days of receipt (Ohio Rev. Code § 3901.381(B)(1)). When reasonable supporting documentation is needed, the window is 45 days (§ 3901.381(B)(2)(a)). The shorter figure is shown. This is a claim-payment deadline, not an appeal-decision deadline.
MHPAEA parity for Aetna in Ohio
Federal MHPAEA (29 USC § 1185a; 29 CFR § 2590.712) applies to Aetna's group health plans operating in Ohio. The CAA 2021 § 203 disclosure duty requires Aetna to produce its NQTL comparative analysis on request.
Aetna's parity posture: Aetna publishes MHPAEA comparative analyses on request; behavioral health benefits are administered through Aetna Behavioral Health. Document parity violation in detail — Aetna's internal process requires a specific MHPAEA flag in the appeal routing system.
State-level parity laws may add further protections in Ohio — check with the state's Department of Insurance for current guidance.
Common Aetna denial codes
Ohio's insurance commissioner
If your internal Aetna appeal is denied, Ohio's Department of Insurance can help with a complaint or external review for fully-insured plans. Look up the official contact via the NAIC consumer locator.
Note: self-funded ERISA plans are generally exempt from state insurance regulation. If your patient's Aetna plan is employer-sponsored and self-funded, your remedies run through the U.S. Department of Labor (EBSA) rather than Ohio's commissioner.
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Generate my appeal letter →Frequently asked questions
How long does Aetna have to respond to an appeal in Ohio?
Aetna generally has 30 calendar days to respond to a Level-1 appeal. Separately, Ohio's prompt-payment statute gives payers 30 days to respond to a clean claim (Ohio Rev. Code § 3901.381) — a different deadline governing claim payment, not the appeal decision.
Does MHPAEA apply to Aetna in Ohio?
Generally, yes — for Aetna's group health plans. Federal MHPAEA (29 CFR § 2590.712) applies to Aetna's group health plans in Ohio. Request Aetna's NQTL comparative analysis under CAA 2021 § 203.
Where do I mail or fax a Aetna appeal?
Mail to Aetna Provider Resolution Team, PO Box 14020, Lexington, KY 40512. You can also fax to 1-860-754-2985. This address is the same nationally, including for Ohio providers.