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Payer Strategy2026-01-057 min read

P2P Reviews by Payer: Aetna vs. Cigna vs. BCBS Compared

How P2P review processes differ between Aetna, Cigna, and Blue Cross Blue Shield. Learn each payer's quirks, criteria sets, and what strategies work best.

Why Payer Strategy Matters

A strategy that works with UnitedHealthcare may fail with Aetna. Each payer uses different criteria sets, has different review processes, and responds to different approaches. Understanding these differences is a significant advantage.

Aetna

Criteria: Aetna uses their own Clinical Policy Bulletins (CPBs) for most reviews. These are publicly available on their website.

Process: Aetna's P2P process is generally straightforward. They have a dedicated P2P scheduling line and typically accommodate scheduling within a few business days.

What works:

  • Reference their specific CPB by name and number
  • Aetna reviewers tend to be receptive to published literature
  • They often respond well to a collaborative, evidence-based approach

    • Watch out for:

  • Aetna CPBs can be quite specific. Know the exact criteria before the call.
  • Some CPBs haven't been updated recently -- if newer evidence supports your case, bring it.

    • Cigna

    Criteria: Cigna uses a mix of InterQual, MCG, and their own coverage policies depending on the service type.

    Process: Cigna's P2P scheduling can take longer. They have specific windows for P2P calls and may not accommodate urgent scheduling as readily.

    What works:

  • Be very organized -- Cigna reviewers tend to be methodical
  • Document exactly which criteria your patient meets or doesn't meet
  • Cigna reviewers often appreciate when you acknowledge the criteria gap and explain why an exception is warranted

    • Watch out for:

  • Cigna sometimes requires you to specify which criteria set you're addressing
  • Their specialty drug reviews have a separate process

    • Blue Cross Blue Shield

    Criteria: Varies significantly by state. Each BCBS plan is independently operated and may use different criteria (InterQual, MCG, or proprietary).

    Process: BCBS P2P processes vary by state. Some are very responsive; others have more bureaucratic processes. Check your local BCBS plan's specific appeal process.

    What works:

  • Research your specific state's BCBS medical policies (available online for most plans)
  • Local BCBS plans often have relationships with local physician communities -- a professional, respectful approach goes far
  • BCBS reviewers often appreciate understanding the local standard of care

    • Watch out for:

  • Don't assume one BCBS plan works like another. CareFirst, BCBS of Texas, and Anthem operate very differently.
  • Some BCBS plans have specific P2P request forms

    • Quick Comparison

    | Factor | Aetna | Cigna | BCBS |

    |--------|-------|-------|------|

    | Primary Criteria | CPBs | Mixed | Varies by state |

    | P2P Scheduling | Fast | Moderate | Varies |

    | Approach | Evidence-based | Methodical | Local relationship |

    | Difficulty | Moderate | Moderate-Hard | Varies |

    The Bottom Line

    Know your payer before you dial. Five minutes of research into the payer's specific criteria and process can be the difference between an overturn and a denial.

    *Have a P2P call with a specific payer? Generate a payer-specific script with our free tool.*

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